Axillary Lymph Node Enlargement Research Articles

TAFRO syndrome: A case report with biopsy findings from three sites

Abstract Introduction/Objective TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) is a rare systemic inflammatory disorder. First reported in 2010, the majority of cases are from Japan, where it is currently regarded as a subtype of HHV8-negative Multicentric Castleman Disease. Methods/Case Report We report a case of TAFRO occurring in a 17-year old from Puerto Rico. She originally presented with abdominal pain, vomiting, and fever, and was also found to have splenomegaly, elevated sedimentation rate and C-reactive protein. Over the course of the next several days she developed respiratory distress, requiring ventilatory support, and anuric renal failure. Renal biopsy demonstrated evidence of thrombotic microangiopathy, which was interpreted as atypical hemolytic syndrome, requiring dialysis and treated with eculizumab. Because other diagnostic considerations at the time also included hemophagocytic lymphohistiocytosis and catastrophic antiphospholipid syndrome, bone marrow examination was performed which demonstrated increased megakaryocytes, without fibrosis or hemophagocytosis. Over the next two months, she developed anasarca with ascites, pleural effusion, pericardial effusion, multiple enlarged axillary and cervical lymph nodes, and persistence of splenomegaly. Biopsy of a left cervical lymph node demonstrated features suggestive of Castlemans disease, plasma cell variant. The constellation of symptoms, laboratory investigations and biopsy diagnoses support the diagnosis of TAFRO syndrome. The patient received rituximab, high dose steroids, and hemodialysis with clinical improvement. At 16 months follow up, the patient is in remission. Results (if a Case Study enter NA) NA Conclusion From a pathology standpoint, the case provides biopsy findings of three distinct organ systems all with relatively unusual findings that together are characteristic of TAFRO syndrome. It highlights the risk of accepting “biopsy proven” diagnoses such as atypical hemolytic uremic syndrome that also require significant laboratory and clinical correlation for true confirmation, and points out the importance and opportunity for pathologists to see the forest along with the trees in order to recognize rare diseases such as TAFRO.

Adult-onset Still\u2019s disease with multiple lymphadenopathy: a case report and literature review

BackgroundAdult-onset Still’s disease (AOSD) often presents with systemic multiple lymphadenopathy. In addition to the common paracortical and mixed patterns in AOSD lymph node histopathological features, other morphological patterns include diffuse, necrotic, and follicular patterns. However, to date, there have been few reports on the histopathological description of AOSD lymph nodes.Case presentationAn 18-year-old woman presented 2 months earlier with pain in her large joints with painless rash formation; bilateral posterior cervical lymph node, left supraclavicular lymph node, and left posterior axillary lymph node enlargement, and no tenderness. Left cervical lymph node resection was performed for pathological examination. The lymph node structure was basically preserved, and subcapsular and medullary sinus structures were observed. Many histiocytes in the sinus were observed, the cortical area was reduced, a few lymphoid follicles of different sizes were observed, and some atrophy and hyperplasia were noted. The lymphoid tissue in the paracortical region of the lymph node was diffusely proliferative and enlarged, mainly comprising histiocytes with abundant cytoplasm, immunoblasts and numerous lymphocytes with slightly irregular, small- to medium-sized nuclei. Nuclear karyorrhexis was easily observed, showing a few nuclear debris and the “starry sky” phenomenon, accompanied by abundantly branching high endothelial small vessels with few scattered plasma cells and eosinophil infiltration. Lymphoid follicle immunophenotype with reactive proliferative changes was observed. Approximately 40% of the cells in the paracortical region were positive for Ki-67, and the histiocytes expressed CD68, CD163, and some expressed S-100, with the absence of myeloperoxidase. The immunoblasts expressed CD30 and CD20, not ALK or CD15. Background small- to medium-sized T cells expressed CD2, CD3, CD5, CD7, CD4, and CD8; the number of CD8-positive T cells was slightly predominant, and a small number of T cells expressed granzyme B and T-cell intracellular antigen 1. The patient received a comprehensive medical treatment after the operation, and her condition was stable without progression at the 11-month follow-up evaluation.ConclusionsThe pathological features of AOSD lymphadenopathy raises the awareness of AOSD among pathologists and clinicians and aids in the diagnosis and differential diagnosis of AOSD lymphadenopathy from other reactive lymphadenopathies (lupus lymphadenitis, etc.) and lymphomas.

COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management.

As mass COVID-19 vaccination is underway, radiologists are encountering transient FDG uptake in normal or enlarged axillary, supraclavicular, and cervical lymph nodes after ipsilateral deltoid vaccination. This phenomenon may confound interpretation in patients with cancer undergoing FDG PET/CT. In this article, we present our institutional approach for management of COVID-19 vaccine-related lymphadenopathy on FDG PET/CT according to early experience. We suggest performing PET/CT at least 2 weeks after vaccination in patients with a cancer for which interpretation is anticipated to be potentially impacted by the vaccination but optimally 4-6 weeks after vaccination given increased immunogenicity of mRNA vaccines and potentially longer time for resolution than lymphadenopathy after other vaccines. PET/CT should not be delayed when clinically indicated to be performed sooner. Details regarding vaccination should be collected at the time of PET/CT to facilitate interpretation. Follow-up recommendations for postvaccination lymphadenopathy are provided, considering the lymph node's morphology and likely clinical relevance. Consideration should be given to administering the vaccine in the arm contralateral to a unilateral cancer to avoid confounding FDG uptake on the side of cancer. Our preliminary experience and suggested institutional approach should guide radiologists in management of patients with cancer undergoing PET/CT after COVID-19 vaccination.

Effects of COVID-19 vaccination on FDG-PET/CT imaging: A literature review.

COVID-19 vaccination using mRNA technology began at the end of 2020 in several countries, approximately 9 months after the WHO declared the new coronavirus a pandemic, and began in Japan at the end of February 2021. Several studies have reported FDG avidity in enlarged axillary lymph nodes as a specific feature of FDG-PET/CT imaging after COVID-19 vaccination. A major concern is that this finding could lead to a misdiagnosis in patients with various types of malignancy. We review the impact of COVID-19 vaccination on the management of patients scheduled for FDG-PET/CT in the setting of nationwide mass vaccination.

Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall

Background and purpose — Cat scratch disease (CSD) is a self-limiting disease caused by Bartonella (B.) henselae. It is characterized by granulomatous infection, most frequently involving lymph nodes. However, it can present with atypical symptoms including musculoskeletal manifestations, posing a diagnostic challenge. We describe the prevalence and demographics of CSD cases referred to a sarcoma center, and describe the radiological, histological, and molecular findings. Patients and methods — Our cohort comprised 10 patients, median age 27 years (12–74) with clinical and radiological findings suspicious of sarcoma. Results — 7 cases involved the upper extremities, and 1 case each involved the axilla, groin, and knee. B. henselae was found in 6 cases tested using polymerase chain reaction and serology in 5 cases. 9 cases were soft tissue lesions and 1 lesion involved the bone. 1 patient had concomitant CSD with melanoma metastasis in enlarged axillary lymph nodes. On MRI, 5 soft tissue lesions were categorized as probably inflammatory. In 3 cases, with still detectable lymph node structure and absent or initial liquefaction, the differential diagnosis included lymph node metastasis. A sarcoma diagnosis was suggested in 4 cases. The MRI imaging features of the bone lesion were suspicious of a bone tumor or osteomyelitis. Interpretation — Atypical imaging findings cause a diagnostic challenge and the differential diagnosis includes malignant neoplasms (such as sarcoma or carcinoma metastasis) and other infections. The distinction between these possibilities is crucial for treatment and prognosis.

Fat-enlarged axillary lymph nodes are associated with node-positive breast cancer in obese patients

PurposeObesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer.MethodsThis retrospective case–control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion.ResultsA strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics.ConclusionFat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

Molybdenum Target X-Ray Features and Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 in Invasive Breast Cancer.

ObjectiveThe aim of this study was to investigate the correlations between molybdenum target X-ray mammography features and the expressions of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in invasive breast cancer (IBC) and their clinical significance.MethodsThe correlations between the mammographic features and expressions of ER, PR, and HER2 in 378 cases of IBC confirmed by pathology were analyzed retrospectively.ResultsThe differences in the ER, PR, and HER2 positive expression between gland types were statistically significant (P < 0.05). The expression of ER was positively correlated with the presence of nipple depression (P < 0.05). Moreover, ER and PR expressions were positively correlated with the absence of axillary lymph node enlargement (P < 0.05) and negatively correlated with the maximum tumor diameter (P < 0.05).ConclusionThe mammographic features of IBC are correlated with the expression of immunity indices ER, PR, and HER2 and reflect several pathological features.

CASE REPORT OF RARE PRESENTATION OF DOUBLE AXILLARY VEIN IN MODIFIED RADICAL MASTECTOMY

62yr old female, known diabetic and hypertension, Post CABG presented with hard, mobile, swelling of size 2×3 cm in upper outer quadrant with Right axillary lymph node enlargement size 1×1 cm diagnosed as Right breast cancer with lymph node enlargement. FNAC of Swelling over right breast shows smear positive for malignancy, Ductal carcinoma of Right breast

Giant fibroadenoma of the breast: a benign breast mass mimicking malignancy

Fibroadenoma is a common benign lesion of the breast that usually occurs in young females. Giant fibroadenoma of the breast is a rare benign pathology, which is defined as fibroadenoma greater than 5 cm in size and/or weighs more than 500 g. It is usually found in adolescent women. A 37-year-old woman undergoing treatment for infertility was referred to the breast clinic with an ulcerating left breast lump that had progressively increased in size. Examination showed a fungating left breast mass that obliterated the nipple-areola complex. Ultrasound showed a large soft tissue mass in the left breast with enlarged left axillary lymph nodes. Computed tomographic (CT) scan showed a 13×17 cm left breast mass. Core biopsy of this mass reported possibility of phyllodes tumor, while axillary fine-needle aspiration cytology (FNAC) showed no evidence of malignancy. Total mastectomy with immediate reconstruction using silicone implant was performed. Final histopathology reported giant fibroadenoma. Most cases on giant fibroadenoma reported in literature are limited to adolescent or young females, however, our patient was relatively old, which makes this a rare case.

Clinico-pathological analysis of primary breast lymphoma: A cross sectional study in a tertiary care hospital

Introduction: Breast being well-developed mammary organ in females is a common site for many non-neoplastic and malignant lesions due to varied underlying etio-pathogenesis. Lymphoma being a malignant clonal proliferation of lymphoid cells, primary breast lymphoma is an unusual entity with non-epithelial origin characterized by florid proliferation of neoplastic lymphoid cells. With uncertain etiology, the clinical presentation is vague with varied radiological and histopathological patterns. In the present study, we analyzed the incidence of primary breast lymphoma with a study on clinico-histopathological pathological spectrum. Methodology: The study was conducted retrospectively and included patients with breast lesions and the histopathological evaluation from their subsequent tissue biopsies. All the clinical data was documented and cytological correlation were done in available cases. Hematological and radiological interpretations are analyzed subsequently as pre-op work up of the patients. Clinico-pathological analysis of the results were done based on knowledge from research works. Results and Observation: The seven years retrospective study included nine cases which fell into the criteria of PBL with average age incidence between 4th & 5th decade occurring retroareolar region with right breast preponderance. Radiological studies picked up malignancy only in few cases but categorization of lymphoma were not reported by imaging. Hematological parameters showed anaemia, leucopenia and pancytopenia depending on extent and involvement of the bone marrow. Histomorphology and subsequent IHC expression stayed gold standard role in diagnosis compared to radiological interpretations. Conclusion: Primary breast lymphoma is rare type of breast cancer with varied presentation. Any patient presenting with solitary, lobulated breast lump in 5th decade, PBL should be kept as one of the differentials especially with anaemia and axillary node enlargement. Clinico-hematological correlation with subsequent histomorphology helps the Pathologist is diagnosing the condition thereby aiding the in Prompt management. Keywords: Breast Lymphoma, Hematological parameters, Histopathology, IHC, Radio-imaging.

Peripheral T-cell Lymphoma, NOS With Epstein-Barr Virus Positivity in an Elderly Patient With Myelodysplastic Syndrome: An Autopsy Case Report

Abstract Casestudy Epstein-Barr virus (EBV)-associated peripheral T-cell lymphomas are a group of aggressive neoplasms with a geographic predilection for South America and Asia, but are very rare in Western populations. Results We report a case of a 74-year-old Caucasian female who presented with pancytopenia and B symptoms with EBV-IgG detected on admission. Past medical history included: ITP, chronic urticaria, and recently diagnosed myelodysplastic syndrome (MDS) on bone marrow biopsy one month prior to admission. Excisional biopsies of an enlarged right neck lymph node (repeated within 6 months) and right axillary lymph node five years ago were negative for a lymphoproliferative disorder at the time. Repeated bone marrow biopsy, performed during the current admission, confirmed the diagnosis of MDS, with scattered T-cells without aberrant immunophenotype. Despite aggressive treatment from multiple specialties, the patient deteriorated and expired four weeks later from complications of MDS. At autopsy, there was diffuse lymphadenopathy involving the mediastinum, axilla, pelvis and peripancreatic fat. Lymph node sections demonstrated nodal architecture effacement by diffuse, vaguely nodular lymphoid infiltrates. Histologically, the infiltrates were composed of medium to large lymphocytes with round to slight irregular nuclei, rare Reed-Sternberg-like multinucleated cells, clumped chromatin, and indistinct nucleoli. Individual cell necrosis was abundant with mitotic figures readily identifiable. Immunohistochemistry revealed CD2+ CD3+ neoplastic T-cells that co-express MUM1 and a subset of CD30, while negative for CD4, CD5, CD8, CD56, ALK1, and TDT. EBV-encoded RNA in-situ hybridization was focally positive. The final postmortem diagnosis was peripheral T-cell lymphoma, not otherwise specified (NOS), with focal EBV positivity. Conclusion Co-existence of a de-novo MDS and non-Hodgkin lymphoma without any prior chemotherapeutic exposure is a highly unusual finding, although MDS-like presentations can occur with EBV-associated lymphomas. Peripheral T-cell lymphoma, NOS is an aggressive lymphoma and EBV positivity has been found correlated with a poor prognosis. This case demonstrates how postmortem examination remains an important tool in clinical- pathological correlation and highlights the potential pathogenetic role EBV plays in MDS and T-cell lymphoma.

S2462 A Patient Presenting With Acute Hepatitis and Retroperitoneal Lymphadenopathy Due to Cytomegalovirus and Epstein-Barr Virus Co-Infection: A Rare Complication in an Immunocompetent Patient

INTRODUCTION: Acute hepatitis refers to an acute inflammation of a liver and hepatic cell necrosis. Viral infection accounts for 95% of cases. Acute viral hepatitis due to cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection in an immunocompetent individual is very rare. We report a patient who presented with fatigue, fever, and retroperitoneal lymphadenopathy due to EBV and CMV infection. CASE DESCRIPTION/METHODS: A 26-year-old man presented with intermittent high-grade fever, nausea, fatigue and generalized body weakness of 1-week duration. The patient noticed a pinkish rash on his abdomen and legs while he was febrile. Otherwise patient denied vomiting, hematemesis, melena, jaundice, or contact with a patient with similar illness. He was not immunocompromised and had no personal history of hematological disorders or autoimmune disease. On examination, the patient was sick looking; blood pressure was 120/68 mmHg, heart rate 110 beats/min, temperature 102 F. He had pink conjunctiva and non-icteric sclera. No palpable lymphadenopathy was felt in accessible areas. The abdomen was nontender, no organomegaly, and no sign of ascites. Laboratory tests revealed a white blood cell count 7.6K, hemoglobin 13.8gm/dl, platelet 163K. Peripheral blood smear revealed lymphocytosis (59%). Alanine transferase 279units/L, aspartate transaminases 217units/L, alkaline phosphatase 121units/L, and total bilirubin of 0.4 mg/dl. Both CMV IgM and IgG were positive, both EBV IgM and IgG were positive. Hepatitis viral panel A, B, C, human immunodeficiency virus, ANA and rheumatoid factor were all negative. Computed tomography of chest/abdomen/pelvis revealed multiple enlarged axillary and retroperitoneal lymph nodes, normal liver and spleen size. DISCUSSION: CMV and EBV are a family of herpes virus commonly encountered during childhood. CMV transmission is either congenital or contact with body secretions or blood transfusion. EBV is transmitted by close contact during child hood or by kissing in adults. Hepatitis as a manifestation of CMV/EBV is rare in an immune-competent patient, but both can present with infectious mononucleosis. Although acute hepatitis can happen in both cases, it is more likely due to CMV. This patient did not have typical symptoms of infectious mononucleosis on presentation, and lymphoma and other causes were considered. A high degree of suspicion helped us to do serology that confirmed the diagnosis. Treatment is supportive in an immune-competent patient.

Fine-needle aspiration cytology of Bacille Calmette-Guerin adenitis: A perplexing distinct clinical entity.

Bacille Calmette-Guerin (BCG) adenitis is a common complication of post-BCG vaccination. Awareness of this lesser known entity in fine-needle aspiration (FNA) is important to prevent misdiagnosis. This study described the clinical presentation, cytomorphological features and disease pattern in patients with BCG adenitis. We analyzed a series of 15 patients with BCG adenitis seen from July 2017 to July 2019. The detailed clinical and cytomorphology of these cases were studied. Age of presentation ranged from 3 to 12 months. Male to female ratio was 2.75:1. A total of four children were diagnosed with primary immunodeficiency. Three children had acyanotic heart disease. Most of the children had left axillary lymph node enlargement. Cytomorphology showed the presence of polymorphs (66.7%), histiocytic aggregates (80%) and reactive lymphoid population (60%). Epithelioid granulomas (26.7%) and giant cells (6.7%) were present. The necrotic background was present in all but one case. Ziehl-Neelsen stain for acid-fast bacilli was positive in all but two cases. A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for patients who are recently vaccinated. FNA cytology, combined with clinical correlation, is useful for diagnosis and management.

ABCL-311: The Burden of Non-Hodgkin Lymphoma Developed in an Ataxia Telangiectasia Child

Context: Ataxia telangiectasia (AT) is an autosomal recessive disorder characterized by progressive neurologic impairment, cerebellar ataxia, immunodeficiency, ocular and cutaneous telangiectasia, and predisposition to malignancy. AT patients have a 100-fold increased risk for the development of lymphoid malignancies, particularly non-Hodgkin lymphomas (NHL). In these patients, severe pulmonary infections are the most frequent cause of death, followed by the combination of pulmonary infection and malignancy. Objective: Evaluation of a clinical case of hematologic malignancy in a child diagnosed with primary immunodeficiency (PID) AT. Methods: We analyzed clinical records, biopsy of lymph node, evaluation of serum immunoglobulins by ELISA, and neurologic involvement by MRI. Results: A 13-year-old boy diagnosed as AT was referred to the Oncologic hospital due to multiple lymphadenopathy. He was born to non-consanguineous healthy parents. Previous medical history revealed waddling gait when he started walking. He was consulted by a neuropediatrician as being suspected of cerebral palsy. Brain MRI revealed cerebellar vermis hypoplasia with enlargement of cisterna magna. The patient also experienced recurrent respiratory infections. At the age of 12 years, the patient had fever of unknown origin for several months, which was unresponsive to antibiotics, and the patient's cervical and submandibular lymph nodes began to enlarge, which progressed. A biopsy was performed, and the patient was diagnosed with NHL, DLBCL type. On presentation, the patient had multiple enlarged cervical, submandibular, axillary, and inguinal lymph nodes and telangiectasia of the bulbar conjunctiva. Neurologic examination revealed decreased tendon reflexes, ataxia, and dysarthria. Laboratory investigations identified a normal complete blood count and biochemistry tests, but the alpha-fetoprotein level was high. There were decreased levels of IgA and IgG and a high level of IgM. Computed tomography showed involvement of cervical, submandibular, axillary, upper mediastinum, and hilum lymph nodes. The patient received CHOP chemotherapy with a reduced dose. The treatment was well-tolerated, despite neutropenia, grade 3 mucositis, and neutropenic fever. Unfortunately, at the last interruption after chemotherapy, the patient had chickenpox and died due to multiple organ failure. Conclusions: Patients with PID have a high risk of developing cancer. It is important to consider AT in a child with pre-existing ataxia or hematologic malignancy that was diagnosed at a younger age than expected.

Case 285.

History A 25-year-old woman was referred to our breast clinic for assessment of a palpable mass in her left breast that developed quickly in 2 weeks. She denied any associated fever, chills, redness, or pain. She had no relevant medical or surgical history; no evidence of recent pregnancy, abortion, or breastfeeding; and no family history of breast cancer. Clinical examination enabled confirmation of a firm mass occupying the retroareolar region and the outer quadrant of the left breast with no skin retraction, edema, or erythema. There was no evidence of enlarged axillary lymph nodes. US of the left breast (Fig 1), bilateral breast MRI (Fig 2), and fluorine 18 fluorodeoxyglucose PET/CT (Fig 3) were performed.

Early progression of breast cancer during neoadjuvant chemotherapy may predict poorer prognoses

Background: In Finland, breast cancers treated with neoadjuvant chemotherapy (NACT) are usually locally advanced and/or have an inflammatory phenotype. We evaluated early NACT responses in breast tumours and lymph nodes and their correlation with survival.Material and methods: We collected a retrospective dataset of 145 patients with very high-risk but non-metastasised breast cancers that were treated with NACT in a Finnish University Hospital between September 2013 and January 2019. The patients underwent magnetic resonance imaging (MRI) scans before beginning NACT and after every second NACT cycle thereafter.Results: The total pathological complete response rate was only 10.7% and breast cancer-specific survival (BCSS) at 24 months was 93.0%. The 2-year breast cancer-specific survival (BCSS) rate was 93.0%, but this varied from 86.5% for the triple-negative subtype to 100.0% for the luminal A-like subtype. Enlargement of the malignant axillary lymph nodes during the first two NACT cycles was associated with poor BCSS rates in HER2-negative patients (p = .00003 in the univariate analysis; hazard ratio = 26.3; 95% confidence interval = 2.66–259.6; p = .005 in the multivariate analysis). Furthermore, progression in the combined diameters of the breast tumours and axillary lymph nodes during the period between a patient’s pre-treatment MRI and her MRI after two NACT cycles was also correlated with worse BCSS rates in both univariate and multivariate analyses.Conclusions: An early MRI assessment after two NACT cycles, specifically of the tumour’s axillary lymph nodes, has the potential to predict short-term BCSS in patients with locally advanced HER2-negative breast cancers.

The Difficulty of Diagnosing Kikuchi-Fujimoto Disease in Infants and Children Under Six Years Old: Case Report and Literature Review

We came across a 20-month-old boy with Kikuchi-Fujimoto disease (KFD) who showed atypical symptoms that were difficult to diagnose. His symptoms were different from those experienced in common clinical KFD cases. Hence, we report his case presentation and review the literature on the difference in KFD symptoms between infants and young children (under six years of age), and school-age children (6 to 20 years).A 20-month-old boy was admitted to our hospital because of prolonged fever and an enlarged right axillary lymph node with pain. He developed erythema, which was like rubella, on the face, trunk, and upper and lower extremities. The rash soon disappeared after two days. The cervical lymph nodes were not palpable. Hepatomegaly and splenomegaly were palpable. Leukopenia and a decrease in platelets were seen in the blood count. Curiously, leukocytosis developed after leukopenia was first observed. Serology titers for several pathogens were negative. A CT scan of the lungs showed swelling of the mediastinal lymph nodes and interstitial pneumonia. The examination of a specimen of the axillary lymph node obtained by biopsy was compatible with KFD.English language reports on KFD were reviewed. Fourteen (14/335: 4.2%) cases in children under six years in addition to the current case and 321 (321/335: 95.8%) cases of school-age children (6-20 years) were found in the literature. Children of school age tend to more commonly be afflicted with KFD, which is characterized by pyrexia, leukopenia, and cervical lymphadenopathy with tenderness. Inversely, major symptoms of KFD patients under six years old were lesions of the lungs in three cases, leukocytosis in six cases, and generalized lymphadenopathy in eight cases, in contrast with symptoms of school-age children.It is concluded that leukocytosis, generalized lymphadenopathy in sites other than the cervical lymph nodes, and lesions of the lungs are characteristic symptoms of severe KFD in patients under six years old, for whom the occurrence is very rare.

Label-free stimulated Raman scattering imaging reveals silicone breast implant material in tissue.

Millions of women worldwide have silicone breast implants. It has been reported that implant failure occurs in approximately a tenth of patients within 10 years, and the consequences of dissemination of silicone debris are poorly understood. Currently, silicone detection in histopathological slides is based on morphological features as no specific immunohistochemical technique is available. Here, we show the feasibility and sensitivity of stimulated Raman scattering (SRS) imaging to specifically detect silicone material in stained histopathological slides, without additional sample treatment. Histology slides of four periprosthetic capsules from different implant types were obtained after explantation, as well as an enlarged axillary lymph node from a patient with a ruptured implant. SRS images coregistered with bright-field images revealed the distribution and quantity of silicone material in the tissue. Fast and high-resolution imaging of histology slides with molecular specificity using SRS provides an opportunity to investigate the role of silicone debris in the pathophysiology of implant-linked diseases.

Predictive value of comb-push ultrasound shear elastography for the differentiation of reactive and metastatic axillary lymph nodes: A preliminary investigation.

ObjectivesTo evaluate the predictive performance of comb-push ultrasound shear elastography for the differentiation of reactive and metastatic axillary lymph nodes.MethodsFrom June 2014 through September 2018, 114 female volunteers (mean age 58.1±13.3 years; range 28–88 years) with enlarged axillary lymph nodes identified by palpation or clinical imaging were prospectively enrolled in the study. Mean, standard deviation and maximum shear wave elastography parameters from 117 lymph nodes were obtained and compared to fine needle aspiration biopsy results. Mann-Whitney U test and ROC curve analysis were performed.ResultsThe axillary lymph nodes were classified as reactive or metastatic based on the fine needle aspiration outcomes. A statistically significant difference between reactive and metastatic axillary lymph nodes was observed based on comb-push ultrasound shear elastography (CUSE) results (p<0.0001) from mean and maximum elasticity values. Mean elasticity showed the best separation with a ROC analysis resulting in 90.5% sensitivity, 94.4% specificity, 0.97 area under the curve, 95% positive predictive value, and 89.5% negative predictive value with a 30.2-kPa threshold.ConclusionsCUSE provided a quantifiable parameter that can be used for the assessment of enlarged axillary lymph nodes to differentiate between reactive and metastatic processes.

Discordant lymphoma: report of one case and review of literature

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of discordant lymphoma. Methods The clinical data of one patient with discordant lymphoma at the PLA Strategic Support Force Characteristic Medical Center were retrospectively analyzed, and the related literatures were reviewed. Results The patient was treated for thrombocytopenia and the examination showed splenomegaly. After hormone treatment, the platelet rebounded and thrombocytopenia occurred during hormone reduction. Splenectomy was performed. Postoperative pathological diagnosis of splenic marginal lymphoma was made and observed. Axillary lymph node enlargement occurred nine months later. Pathological diagnosis of diffuse large B-cell lymphoma was made by using lymph node biopsy, and the disease condition was alleviated after immunotherapy combined with chemotherapy. Conclusions Discordant lymphoma is rare and shows no special clinical manifestations. Its diagnosis should rely on pathological examination. Immunotherapy combined with chemotherapy may be more effective. Key words: Lymphoma, B-cell, marginal zone; Lymphoma, large B-cell, diffuse; Discordant lymphoma; Pathogenesis; Diagnosis; Prognosis