Absence Of Lymphadenopathy Research Articles

Orbital masses as a rare presentation of Rosai-Dorfman disease: Clinicopathologic characterization of five cases

Rosai-Dorfman disease (RDD) is a rare, non-Langerhans cell histiocytosis. Most cases present with marked, non-tender lymphadenopathy due to the proliferation of atypical histiocytes. A minority of cases involves extranodal sites and can present as bone lesions, skin rashes, pulmonary nodules, and rarely orbital masses. Orbital involvement in RDD is rare and may infrequently present as an isolated tumor mass without lymphadenopathy. This study aims to better characterize this uncommon presentation of this rare disease. Five cases of orbital RDD were identified from the last 18 years and the clinical characteristics of each case were compared with histopathological findings. Three men and two women ages 12–36 presented with complaints of eye swelling and/or vision changes. One patient had a history of neurofibromatosis type I and inflammatory pseudotumors while the other four had no signs of systemic disease or other sites of extranodal involvement at the time of presentation. Masses ranged in size from 1.0 cm to 3.5 cm and primarily involved the superior orbit. Resected lesions all displayed characteristic findings of admixed atypical histiocytes, lymphocytes, and plasma cells with a fibrotic background. Emperipolesis was seen in all cases. Immunostaining for S100 and CD68 was diffusely positive in the histiocyte population. Clinical follow-up was obtained for 4 of 5 patients: all four were disease-free at 1 to 15 years after resection. RDD should be considered in the differential for patients with orbital masses, even in the absence of lymphadenopathy or signs of systemic disease.

A rare presentation of Rosai-Dorfman-Destombes disease with central nervous system involvement and cutaneous wounds.

The aim of this case report is to investigate an uncommon presentation of Rosai-Dorfman-Destombes (RDD) disease, and discuss possible differential diagnoses and treatment options for this pathology. RDD is a rare disorder of histiocytes that typically presents in patients as painless cervical lymphadenopathy. However, this case involves a patient with the central nervous system (CNS) type of RDD who later developed cutaneous lesions. Several differential diagnoses were examined, including hidradenitis suppurativa, pilonidal cyst and pressure ulcers. It is important to be able to exclude these diagnoses based on the presentation, patient demographic and wound location. Biopsies verified the presence of RDD in the patient's suprasellar hypothalamic mass and skin lesions, confirming the patient had both CNS-RDD and cutaneous-RDD in the absence of lymphadenopathy. Recognising the unique manifestations of rare diseases such as RDD prevents delay of proper intervention and treatment.

Unusual presentation of extranodal Rosai-Dorfman disease: A scalp lump

Rosai-Dorfman disease (RDD) is a benign and idiopathic proliferative histiocytic disorder that typically manifests with extensive cervical lymphadenopathy, fever, polyclonal gammopathy, and leukocytosis with neutrophilia. However, the purely cutaneous variant of RDD is exceptionally uncommon, occurring in only 3% of all RDD cases. In this abstract, we present a rare case of RDD exhibiting a purely cutaneous form. The patient, a 40-year-old male, presented with a scalp lump. Diagnostic investigations, including histopathological examination, confirmed the diagnosis of RDD. No lymphadenopathy or systemic involvement was detected, highlighting the uniqueness of the cutaneous presentation. The rarity of pure cutaneous RDD underscores the significance of reporting such cases to enhance our understanding of the diverse clinical manifestations of this condition. Awareness of this atypical presentation is crucial for accurate diagnosis and appropriate management, as the treatment approach for purely cutaneous RDD may differ from the more common systemic forms. Through this case report, we aim to contribute to the existing medical literature on RDD, emphasizing the need for careful evaluation of skin lesions to include RDD in the differential diagnosis, even in the absence of lymphadenopathy or systemic symptoms. Further research and documentation of similar cases will undoubt­edly advance our knowledge of this intriguing disease and aid clinicians in providing optimal patient care.

FRI559 An Uncommon Association Of Two Common Etiologies Of Hyperthyroidism

Abstract Disclosure: C. Chew: None. Introduction: Subacute thyroiditis and Graves’ disease are two common etiologies of hyperthyroidism. Association of these two diseases in patient presented with recurrent hyperthyroidism has rarely been reported. Case Report: A 35 years old women, with no known medical illness, was referred to Endocrine Clinic for painful anterior neck swelling associated with palpitation for 2 weeks. The symptoms were preceded by 3 days history of sore throat and mild fever She denied other symptoms of hyperthyroidism. Her last menses was 3 weeks prior. On physical examination, she was tachycardic with heart rate of 115 beats per minute. Her blood pressure was 135/90 mmHg and she was afebrile. There was a tender and diffusely enlarged goiter. However, there were no signs of thyroid eye disease and other signs of hyperthyroidism. Examinations of her throat, lung, abdomen, cardiovascular system and neurological system were unremarkable. There was also absence of lymphadenopathy. She denied family history of thyroid disease. Results of laboratory investigations were suggestive of hyperthyroidism secondary to subacute thyroiditis: Free T4 52 pmol/L (8-16), TSH <0.01 mIU/L (0.45-4.50), TRAb 0.8 IU/L (0-1.0) and ESR 108 mm/hr (1-10). The technetium scan showed mildly enlarged gland with decreased uptake of Tc-99m tracer suggestive of thyroiditis. She was treated with Ibuprofen and Propranolol, and her symptoms improved. At 6 weeks follow up, her thyroid function normalized with Free T4 of 13 pmol/L (8-16), TSH of 1.28 mIU/L (0.45-4.50). However, she complained of weight loss and palpitation at 6 months follow up. Examination revealed a small painless diffuse goiter and she was tachycardic with heart rate of 115 beats per minute. Thyroid function test confirmed recurrence of hyperthyroidism: free T4 45.8 pmol/L (8-16) and TSH <0.01 mIU/L (0.45-4.50). Elevated TSH receptor antibody (TRAb) level at 16.8 IU/L confirmed the diagnosis of Graves’ disease. Carbimazole was then started. Discussion: Subacute thyroiditis and Graves’ disease are two common etiologies of hyperthyroidism. The incidence of association of these two diseases had been reported to be rare at 0.15% in patients with Graves’ disease and 0.76% in patients with subacute thyroiditis (1). The postulated mechanism of the association is that the release of thyroid antigens and corresponding activation of the immune system due to viral invasion of the thyroid gland in subacute thyroiditis may cause the subsequent Graves’ disease (1,2). Conclusion: Graves’ disease should be suspected in patient with persistent or recurrent hyperthyroidism after an episode of subacute thyroiditis although it is rare. Reference: 1. Nakano Y et al. Graves’ disease following subacute thyroiditis. Tohoku J. Exp. Med. 2011; 225:301-309. 2. Bartalena L et al. Graves’ disease occurring after subacute thyroiditis. Report of a case and review of the literature. Thyroid. 1996; 4:345-348. Presentation: Friday, June 16, 2023

Rosai-Dorfman Disease With Pure and Multifocal Cutaneous Lesions: A Case Report

A 52‐year‐old woman developed progressive infiltrated purple and hyperpigmented cutaneous lesions in the face, thighs, armpits, chest, and abdomen evolving forone year. Histopathological examination showed large histiocytes exhibiting intact inflammatory cells in their cytoplasm (emperipolesis). Immunohistochemical analyses showed that the histiocyte population was positive for S100 and CD68, but negative for CD1a. Based on the clinical, histopathological, and immunohistochemical findings, we made the diagnosis of Rosai Dorfman disease (RDD). Our patient didn’t manifest any other extra-cutaneous involvement and all the biological and radiological investigations were normal. This form of pure cutaneous RDD (P-CRDD) with multifocal lesions has been rarely reported. RDD is very rare and hardly recognized in the absence of lymphadenopathy. The diagnosis of this entity involves a combination of histology and immunohistochemistry. To date, there is no standard treatment.

The role of sentinel lymph node biopsy in extramammary paget disease: a systematic review.

Sentinel lymph node biopsy is increasingly used to detect subclinical nodal metastases in extramammary Paget disease. We performed a comprehensive systematic review of the literature to further explore the role of sentinel lymph node biopsy in extramammary Paget disease. Five databases were searched for relevant terms. Articles were included if they were in English and presented primary data on at least one patient with extramammary Paget disease who underwent sentinel lymph node biopsy in the absence of lymphadenopathy or known metastatic disease. Twenty-eight articles were included, with 366 subjects. Seventy-seven sentinel node biopsies (21.2%) were positive, including 12 in which the primary tumor had microinvasion (15.6%) and 56 with deep invasion (72.7%). Of the positive cases, 11 (14.3%) had no further treatment, 54 (70.1%) underwent nodal dissection, 4 (5.2%) were treated with systemic agents, and 1 (1.3%) had radiation. After a mean follow up of 24months, 9 subjects with a positive lymph node biopsy experienced nodal recurrence (11.7%), 15 had distant metastases (19.5%), and 13 died of the disease (16.9%). In conclusion, invasive extramammary Paget disease is strongly associated with poor outcomes including nodal metastasis, distant metastasis, and disease specific death. Sentinel lymph node biopsy is a useful tool to screen for subclinical nodal metastases in invasive disease, and can be used to help guide clinical management.

Склеродермоформная базалиома кожи у пожилой женщины

The most commonly detected non-melacytic skin tumor in humans is "basal cell carcinoma". There are many clinical varieties of this tumor, some of which are quite rare. The attention of specialists is brought to the attention of a clinical observation of an elderly woman who was observed on an outpatient basis by a dermatologist with a rare form of basal cell carcinoma of the skin of the back. Of particular interest is a long history of the disease for about 15 years, the presence of a scar-like large lesion on the back of more than 11 cm in diameter, the absence of lymphadenopathy and weight loss, with a histologically confirmed sclerodema-like basalioma of the skin.

Трудности дифференциальной диагностики лимфаденопатии при остром бруцеллезе (клинические случаи)

Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella, characterized by prolonged fever with damage to the musculoskeletal system, nervous, reproductive, cardiovascular and other systems, prone to chronic course. The highest incidence of brucellosis (including among children) over the past 10 years in Russia is registered in Dagestan. One of the manifestations of the reaction of the immune system to the spread of infection in the acute course of brucellosis is generalized lymphadenopathy. Brucella is able to induce incomplete phagocytosis, as a result of which, with a significant accumulation of the pathogen, the lymph nodes become a source of bacteria reproduction, from where they can enter the bloodstream and spread to the cells of the mononuclear phagocyte system, liver, spleen, bone marrow and other organs. With long-term preservation of the pathogen in tissues and organs, brucella causes a specific inflammatory reaction with the formation of granulomas. The acute form of brucellosis is characterized by high fever with a fairly good tolerance. At the end of the first week of the disease, lymphadenopathy appears, an increase in the liver and spleen. All groups of lymph nodes can increase, they can be sensitive to palpation. With the transition of the acute form of brucellosis to the chronic form, the size of the lymph nodes often decrease, sclerosis, become dense on palpation and painless. This condition is called micropolyadenitis. According to the literature, the frequency of lymphadenopathy in the acute course of brucellosis varies greatly, which, apparently, is due to the lack of clear criteria for assessing damage to the lymph nodes, as well as assessing the duration of the disease and the presence of the fact of prescribed antibiotic therapy. The study of lymph nodes in brucellosis is an important part of the general examination of the patient, however, the presence of lymphadenopathy does not always indicate the course of this nosology. In addition, the absence of lymphadenopathy does not rule out brucellosis. The article presents three clinical cases that demonstrate the difficulty in diagnosing brucellosis and the low alertness of doctors in relation to this disease in a non-endemic region.

Abstract P5-01-05: A Predictive Model for Axillary Pathologic Response after Neoadjuvant Chemotherapy for Clinically Node-Positive Breast Cancer

Abstract Purpose: Neoadjuvant chemotherapy (NAC) has resulted in the eradication of axillary lymph node metastasis in approximately 40% of patients. Sentinel lymph node biopsy (SLNB) could be an alternative surgical procedure for these patients to avoid complications from axillary lymph node dissection (ALND). However, high false-negative rates of SLNB for clinically node-positive patients were reported in previous prospective trials. The aim of the present study was to evaluate clinicopathological factors and imaging characteristics by MRI and ultrasound (US) as predictors of axillary pathologic complete response (ypN0) after NAC, which enables to identify candidates for SLNB in patients with clinically node-positive disease. Patients and methods: We identified 177 patients with clinically node-positive breast cancer who received NAC from May 2009 to May 2021. All patients underwent MRI and US before and after NAC. Patients were judged to be node-positive when they have the cytologically-proven nodal disease by fine-needle aspiration (FNA) or suspicious lymph nodes by diagnostic imaging. Lymph nodes with the cortical thickness (>3.5mm), loss of fatty hilum, or round shape (short-axis/long-axis ratio > 0.5) were defined as suspicious lymph nodes. To develop a predictive model for ypN0, the association between ypN0 status and clinicopathological and imaging characteristics was assessed by multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was used to evaluate discrimination by the model. The model was further evaluated in the validation cohort with 20 patients who received NAC from March 2021 to December 2021. Results: The median age was 54.0 (range: 22-79) years and the mean tumor size was 3.97 ±2.29cm. Of 177 patients, 90 (50.8%) patients had luminal, 47 (26.6%) had HER2-positive, and 40 (22.6%) had triple-negative disease. Sequential anthracycline and taxane were administered for 157 (88.7%) patients, and 45 (95.7%) patients with HER2-positive-disease received concomitant anti-HER2 agents preoperatively. Overall, 77 (43.5%) patients achieved ypN0. Independent predictors of ypN0 status were clinical stage N1 (odds ratio [OR]: 9.17 vs. cN2-3, p=0.002), absence of lymphadenopathy after NAC (OR: 8.54, p< 0.001), breast complete response (CR) by MRI (OR: 5.96, p< 0.001), HER2 positivity (OR: 3.80, p=0.008), nuclear grade (NG) 3 (OR: 2.77 vs. NG1-2, P=0.020) and hormone receptor negativity (OR: 2.52, p=0.048). In a model using these predictors, the area under the ROC curve was 0.887 (95% confidence interval: 0.839-0.935, p< 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the model were 80.0%, 82.8%, 77.9% and 84.5%, respectively. In the validation cohort, the sensitivity, specificity, positive predictive value and negative predictive value were 66.7%, 90.9%, 85.7% and 76.9%, respectively. Among 84 patients who were predicted ypN0 by the model, SLNB was performed in 42 (50.0%) patients, and the identification rate of SLN was 95.2% (40/42). Overall, ALND was omitted in 38 (45.2%) patients and irradiation to regional lymph nodes was performed in 23 (60.5%) out of 38 patients. After a median follow-up of 53.9 months, 5-year recurrence-free survival was comparable between patients with or without ALND (78.0% vs. 94.4%, p=0.259). Conclusions: Our predictive model based on clinicopathological factors and imaging characteristics by MRI and US could help to identify good candidates for the omission of ALND after NAC in patients with clinically node-positive breast cancer. Citation Format: Akiko Matsumoto, Saki Naruse, Yuka Isono, Yuka Maeda, Ayana Sato, Miki Yamada, Tatsuhiko Ikeda, Hiromitsu Jinno. A Predictive Model for Axillary Pathologic Response after Neoadjuvant Chemotherapy for Clinically Node-Positive Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-01-05.

The role of multiparametric MRI in differentiating uterine leiomyosarcoma from benign degenerative leiomyoma and leiomyoma variants: a retrospective analysis

To assess qualitative and quantitative magnetic resonance imaging (MRI) factors that can help distinguish leiomyosarcoma (LMS) from benign degenerative leiomyoma (BDL) and leiomyoma variants (LV) and assess the interobserver agreement for the proposed quantitative factors. Retrospective analysis of all histopathology proven cases of LV, BDL, and LMS with a preoperative MRI was performed. Twenty-seven cases were included (five LMS, three LV, and 19 BDL) with each case independently read by a pair of radiologists. Lesion size, margins, presence or absence of degeneration, necrosis, and haemorrhage were assessed on MRI along with quantitative factors such as mean T2-weighted (W) and T1W signal intensity, T1W signal heterogeneity, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) ratios as well as dynamic contrast enhancement (DCE) characteristics along with the presence or absence of lymphadenopathy and extra-uterine and peritoneal spread. Mean and standard deviation for quantitative variables and frequency with percentages for qualitative variables were assessed. Infiltrative margins were seen exclusively in the LMS group (n=1), with the remaining LMS cases showing lobulate or rounded smooth margins similar to BDL or LV. A high T2W signal <25% was seen exclusively in the BDL group (n=8). The presence of concomitant necrosis and haemorrhage was seen exclusively in the LMS group (n=2). Quantitative MRI had good inter-reader correlation but was not significantly different between the LMS, BDL, and LV groups. LMS, BDL, and LV may have overlapping features on multiparametric MRI making differentiation difficult.

Recommendations for an Approach to Random Skin Biopsy in the Diagnosis of Intravascular B-Cell Lymphoma.

Intravascular B-Cell Lymphoma (IVBCL) is a rare type of extranodal large B-cell lymphoma where clonal B-cells selectively home to and replicate in the lumen of small vessels. Random skin biopsy (RSB) of uninvolved skin is a reputable tool to diagnose this protean entity and thus dermatologists are involved in its diagnosis. A literature review was completed to derive an approach to RSB in these patients to maximize diagnostic yield of IVBCL and minimize morbidity. Based on this review, data from 27 patients where clinical signs and symptoms and results of investigations were able to be linked to a positive diagnosis of IVBCL from RSB from 11 papers from 2003 to 2021 were analyzed. Following this analysis, RSB should be considered when there are no clinical skin findings and there is an elevated lactate dehydrogenase in the absence of lymphadenopathy and presence of fever of unknown origin, thrombocytopenia, anemia, and ferritinemia. Three to four RSBs from the thigh, abdomen and/or posterior upper arm should be performed via either incisional or telescoping punch biopsies and should include senile/cherry angioma(s) if present. If RSB results in a diagnosis of IVBCL, hematology should be consulted for further management. Consideration of a false negative biopsy or alternative diagnoses should be explored if RSB is negative for IVBCL. Following a standard approach for RSB in these patients will increase diagnostic yield of IVBCL while decreasing the risk of harm to the patient.

Diffuse large B-cell lymphoma presenting with paraparesis.

The development of paraparesis in the setting of back pain and lassitude in an immunocompetent patient was diagnosed as the presenting feature of diffuse large B-cell lymphoma. MRI imaging and surgical biopsy were diagnostic, despite the absence of lymphadenopathy or splenomegaly, and near-normal laboratory workup. Different possible pathological mechanisms of paraparesis in large B-cell lymphoma are discussed.

Cutaneous Rosai-Dorfman Disease – A Case Report and Review of Literature

Rosai–Dorfman disease (RDD), or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a self-limiting, rare benign proliferative disorder of histiocytes in the lymph nodes with occasional extra-nodal involvement of the skin. Isolated Cutaneous Rosai-Dorfman disease(C-RDD) without node involvement is an exceedingly rare occurrence. Despite its unique characteristics, the diagnosis of Cutaneous Rosai Dorfman disease is hampered by its variable clinical presentation, misleading histopathological patterns, and the absence of lymphadenopathy. Herein we present a case report of Cutaneous Rosai-Dorfman disease without any lymph node involvement.

Ambiguous and Incomplete: Natural Language Processing Reveals Problematic Reporting Styles in Thyroid Ultrasound Reports.

Natural language processing (NLP) systems convert unstructured text into analyzable data. Here, we describe the performance measures of NLP to capture granular details on nodules from thyroid ultrasound (US) reports and reveal critical issues with reporting language. We iteratively developed NLP tools using clinical Text Analysis and Knowledge Extraction System (cTAKES) and thyroid US reports from 2007 to 2013. We incorporated nine nodule features for NLP extraction. Next, we evaluated the precision, recall, and accuracy of our NLP tools using a separate set of US reports from an academic medical center (A) and a regional health care system (B) during the same period. Two physicians manually annotated each test-set report. A third physician then adjudicated discrepancies. The adjudicated "gold standard" was then used to evaluate NLP performance on the test-set. A total of 243 thyroid US reports contained 6,405 data elements. Inter-annotator agreement for all elements was 91.3%. Compared with the gold standard, overall recall of the NLP tool was 90%. NLP recall for thyroid lobe or isthmus characteristics was: laterality 96% and size 95%. NLP accuracy for nodule characteristics was: laterality 92%, size 92%, calcifications 76%, vascularity 65%, echogenicity 62%, contents 76%, and borders 40%. NLP recall for presence or absence of lymphadenopathy was 61%. Reporting style accounted for 18% errors. For example, the word "heterogeneous" interchangeably referred to nodule contents or echogenicity. While nodule dimensions and laterality were often described, US reports only described contents, echogenicity, vascularity, calcifications, borders, and lymphadenopathy, 46, 41, 17, 15, 9, and 41% of the time, respectively. Most nodule characteristics were equally likely to be described at hospital A compared with hospital B. NLP can automate extraction of critical information from thyroid US reports. However, ambiguous and incomplete reporting language hinders performance of NLP systems regardless of institutional setting. Standardized or synoptic thyroid US reports could improve NLP performance.

ADDRESSING THE INFILTRATIVE PATTERN: COMPLEX DIAGNOSIS

Alterations in liver function tests are frequent, so the approach based on the predominant alteration and the patient's medical history is relevant. Carrying out a liver biopsy in cases of diagnostic doubt is imperative. The objective of this work is to describe a clinical case of an infiltrative pattern approach that culminated in the diagnosis of Hepatosplenic T-cell Lymphoma (HSCTL). Clinical case report. Presentation. Woman, 72 years old. History of a sister with cirrhosis. Consumption of alcohol and herbalists; arterial hypertension and Sjögren. He was admitted for persistent fatigue and jaundice. Laboratories with anemia, thrombocytopenia and kidney injury; Hepatic biochemistry with a predominantly cholestatic pattern at the expense of alkaline phosphatase and direct hyperbilirubinemia. Without acute liver failure. By imaging the liver, vessels and normal bile duct; splenomegaly; Negative hepatitis viral panel, positive ANAs and Anti-actin, negative antimitochondrials, normal immunoglobulins. HAI vs. DILI / HILI is suspected. Liver biopsy reports HSTCL-type lymphoproliferative process (Figure 1). It was supplemented with bone marrow aspirate and PET-CT. He started prednisone and cyclophosphamide. The systematic approach to altered liver biochemistry requires integrating personal and family risk factors for liver disease. The infiltrative pattern that resembles the cholestatic one represents a diagnostic challenge as it is little recognized. In this case, we report a rare neoplasm corresponding to 5% of peripheral T lymphomas; they usually develop in young adults and in the absence of lymphadenopathy. It also has an adverse prognosis due to refractoriness to chemotherapy. The HSTCL presented in this clinical case represents a complex and infrequent diagnosis. The symptoms and age group were atypical and the identification was possible through a systematic evaluation of the infiltrative pattern and differential diagnoses. The authors declare that there is no conflict of interest.

Alterations of the 70\xa0kDa heat shock protein (HSP70) and sequestosome-1 (p62) in women with breast cancer

Peripheral blood mononuclear cells (PBMCs) respond to altered physiological conditions to alleviate the threat. Production of the 70 kDa heat shock protein (HSP70) is up-regulated to protect proteins from degradation. Sequestosome-1 (p62) binds to altered proteins and the p62-protein complex is degraded by autophagy. P62 is also a regulator of intracellular kinase activity and cell differentiation. We hypothesized that the PBMC response to a malignant breast mass involves elevated production of HSP70 and a decrease in intracellular p62. In this study 46 women had their breast mass excised. PBMCs were isolated and intracellular levels of HSP70 and p62 were quantitated by ELISA. Differences between women with a benign or malignant breast mass were determined. A breast malignancy was diagnosed in 38 women (82.6%) while 8 had a benign lesion. Mean intracellular HSP70 levels were 79.3 ng/ml in PBMCs from women with a malignant lesion as opposed to 44.2 ng/ml in controls (p = 0.04). The mean PBMC p62 level was 2.3 ng/ml in women with a benign breast lesion as opposed to 0.6 ng/ml in those with breast cancer (p < 0.001). Mean p62 levels were lowest in women with invasive carcinoma and a positive lymph node biopsy when compared to those with in-situ carcinoma or absence of lymphadenopathy, respectively. Intracellular HSP70 and p62 levels in PBMCs differ between women with a malignant or benign breast lesion. These measurements may be of value in the preoperative triage of women with a breast mass.

CD30+ Anaplastic Enteropathy-Associated T-cell Lymphoma Mimicking Crohn’s Disease

Abstract Introduction/Objective Enteropathy-associated T-cell lymphoma (EATL) is an aggressive peripheral T-cell lymphoma with a very poor prognosis. It is not uncommon for patients with EATL to present with intestinal obstruction or perforation, with the diagnosis made following surgical resection or autopsy. Although EATL is associated with celiac disease, this diagnosis may be made concomitant with EATL. The symptomology is often non-specific, particularly without a known history of celiac disease, and progression may be rapid. Methods/Case Report We describe the case of a 57 year old male who presented with several months of diarrhea, fatigue, night sweats, severe weight loss, and failure to thrive. Initial workup indicated positivity for Clostridium difficile and cryptosporidium, leading to antibiotic treatment. His symptoms persisted without significant improvement and a presumptive diagnosis of Crohn’s disease was made based on colonoscopy with biopsy and imaging that showed inflammatory changes with entero-enteric fistula formation. Further clinical decline necessitated exploratory laparotomy which revealed multiple enteric strictures, intra-loop abscesses, and necrotic ulceration necessitating segmental ileal resections. There was no associated lymphadenopathy. Microscopically, there was a dense, polymorphic lymphoid population within the bowel wall with associated mucosal ulceration and abundant necrosis. Striking anaplastic cytomorphology was present, with a heavy intratumoral eosinophilic infiltrate. Neoplastic lymphocytes were CD3+, CD30+ T cells with a CD7+, CD5-, CD4-, CD8-, CD56-, ALK- immunophenotype. The adjacent intestinal mucosa showed features of celiac disease (villous atrophy, intraepithelial lymphocytosis). Results (if a Case Study enter NA) NA Conclusion The prominent anaplastic morphology in combination with strong, diffuse CD30 expression prompted consideration of other T cell lymphomas, including anaplastic large cell lymphoma and peripheral T cell lymphoma, NOS, within the differential. The presence of coexisting histologic changes of celiac disease, dense eosinophilic infiltrate, and absence of lymphadenopathy were clues to the correct diagnosis. Notably, the frequency of CD30 expression in EATL is variable but common among cases manifesting large cell morphology.

The clinicopathological characteristics, prognosis, and CT features of ovary metastasis from colorectal carcinoma.

BackgroundThe aim of this study was to study patients diagnosed with ovary metastasis from colorectal carcinoma (OM-CRC) regarding their clinical manifestations, pathological characteristics and developments based on the results of computed tomography (CT).MethodsResearch was conducted with OM-CRC admissions to our facility during the period of January, 2000 to January, 2020, with examinations of both patients and imaging statistics.ResultsA group of 21 female participants with a median age of 54-year-old, ranging from 48 to 68 years old, were investigated. In the univariate analyses, synchronous metastasis and R2 resection (macroscopic residual lesions) during cytoreductive surgery (CRS) were shown to be negatively associated with the OM-CRC prognosis. Results of the multivariate analysis showed that R2 resection during CRS was the only independent predictor of the overall survival (OS) rate as well as the progression-free survival (PFS) rate. OM-CRC cases frequently exhibited a well-defined borderline (90.9%), predominantly cystic ovarian mass (90.9%), heterogeneous enhancement (72.3%), moderate enhancement (63.6%), peritoneal implantation (81.8%) and an absence of lymphadenopathy (90.9%).ConclusionsIt is important to develop a thorough comprehension of the pathological characteristics as well as developments of OM-CRC, in order to understand its diagnosis, develop useful therapeutic interventions, and predict accurate prognosis. Nevertheless, OM-CRC is an uncommon malignant ovarian tumor and a good prognosis requires a CRS without macroscopic residual lesions, as a significant finding of our study.

Abstract PS1-29: Predicting axillary pathologic response to neoadjuvant chemotherapy for node-positive breast cancer: Clinical predictive model by using MRI and ultrasound

Abstract Purpose: Neoadjuvant chemotherapy (NAC) has been shown to eradicate axillary lymph node metastasis in approximately 40% of patients. Sentinel lymph node biopsy (SLNB) could be an alternative surgical approach for these patients to avoid morbidity from axillary lymph node dissection (ALND). However, high false-negative rates of SLNB for initially node-positive patients were reported in previous trials. The aim of this study was to evaluate clinicopathological factors and imaging characteristics by MRI and ultrasound (US) as predictors of axillary pathologic complete response (ypN0) after NAC, which enable to identify candidates for SLNB in patients with clinically node-positive disease. Patients and methods: We identified 153 patients with clinically node-positive breast cancer who received NAC from May 2009 to December 2019. Clinicopathological data including age, clinical T/N status, nuclear grade, hormone receptor (HR) and HER2 status were collected. All patients underwent MRI and US before and after NAC. Patients were judged to be node-positive when they have cytologically-proven nodal disease by fine-needle aspiration (FNA) or suspicious lymph nodes by diagnostic imaging. Lymph nodes with cortical thickness (&amp;gt;3.5mm), loss of fatty hilum or round shape (short-axis/long-axis ratio &amp;gt; 0.5) were defined as suspicious lymph nodes. All imaging data were evaluated at baseline and after NAC. To develop a predictive model for ypN0, the association between ypN0 status and clinicopathological and imaging characteristics were assessed by multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was used to evaluate discrimination by the model. Results: The median age was 55.0 (range: 22-79) years and the mean tumor size was 3.86 ± 2.04 cm. Pretherapeutic lymph node status was assessed by FNA in 88 (57.5%) patients. Of 153 patients, 80 (52.3%) patients had luminal, 39 (25.5%) had HER2-positive, and 34 (22.2%) had triple negative disease. Sequential anthracycline and taxane were administered for 138 (90.2%) patients, and 37 (94.9%) patients with HER2-positive-disease received concomitant anti-HER2 agents preoperatively. Overall, 62 (40.5%) patients achieved ypN0. Independent predictors of ypN0 status were breast complete response by MRI (odds ratio [OR]: 9.01, p&amp;lt;0.001), clinical stage N1 (OR: 6.64 vs. cN2-3, p=0.009), absence of lymphadenopathy after NAC (OR: 6.09, p&amp;lt;0.001), HR negativity (OR: 3.10, p=0.02) and HER2 positivity (OR: 2.87, p=0.04). In a model using these predictors, the area under the ROC curve was 0.870 (95% confidence interval: 0.814-0.925, p&amp;lt;0.001). Sensitivity, specificity, positive predictive value and negative predictive value of the model were 72.6%, 86.8%, 78.9% and 82.3%, respectively. After a median follow-up of 49.7 months, 5-year disease-free survival (DFS) was significantly higher in patients who achieved ypN0 than patients with residual axillary disease (88.7% vs. 76.9%, p=0.046). Among 62 patients who achieved ypN0 after NAC, ALND was omitted in 24 (38.7%) patients and irradiation to regional lymph nodes was performed in 8 (33.3%) out of 24 patients. Five-year DFS was comparable between patients with or without ALND (86.8% vs. 91.7%, p=0.815). Conclusions: Our predictive model based on imaging characteristics by MRI and US could help to identify good candidates for omission of ALND after NAC in patients with initially node-positive breast cancer. Citation Format: Akiko Matsumoto, Miki Yamada, Daisuke Tsukahara, Yasuko Umemoto, Hiromitsu Jinno. Predicting axillary pathologic response to neoadjuvant chemotherapy for node-positive breast cancer: Clinical predictive model by using MRI and ultrasound [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-29.

Chronic Lymphocytic Leukaemia Unmasked by COVID-19 Infection: A Case Report

Corona Virus Disease 2019 (COVID-19) caused by SARS Cov-2 is an Ribonucleic Acid (RNA) virus which spreads through respiratory route. It was first detected in Wuhan, China in December 2019. World Health Organisation (WHO) declared it as worldwide pandemic in March 2020. Clinically, it can present from mild flu like disease to severe respiratory illness. Reverse Transcription Polymerase Chain Reaction (RT-PCR) is the method for confirmation. Chronic lymphocytic leukaemia is a lymphoproliferative disorder that presents as absolute lymphocytosis with proliferation of monoclonal mature B lymphocytes, unlike other causes of reactive lymphocytosis. Patients with chronic lymphocytic leukaemia often have defects in humoral and cellular immune system. Therefore, these patients have strong predisposition to recurrent infections and in this case for COVID-19. The relationship between chronic lymphocytic leukaemic and COVID-19 is not very clearly understood. A 77-year-old male with no significant co-morbidities presented with cough, fever and shortness of breath. His High-Resolution Computed Tomography (HRCT) chest revealed non-specific interstitial pneumonia and was tested positive for COVID-19 infection on RT-PCR. A Complete Blood Count (CBC) showed a high Total Leukocyte Count (TLC) with absolute lymphocytosis. There was absence of lymphadenopathy or splenomegaly. Flow cytometry confirmed the diagnosis of Chronic lymphocytic leukaemia. He was offered convalescent plasma therapy and later had to be incubated because of multiorgan failure. His Absolute Lymphocyte Counts (ALC) more than doubled in a week’s time. COVID-19 infection usually presents with lymphopenia, lymphocytosis should always raise a suspicion of underlying haematological malignancy or secondary infection.