Axillary Lymphadenopathy Research Articles

The spectrum of cytological findings in patients with BCG lymphadenitis: A series of 13 cases

ContextBacillus Calmette–Guérin (BCG) vaccine has been used to prevent tuberculosis and/or its severe complications for long. BCG lymphadenitis is a common complication of the vaccine, which is sometimes subjected to cytological examination.The aim of the study is to describe the cytological findings of BCG lymphadenitis. SettingsThe study was conducted in a tertiary care hospital in the western part of India from January 2021 to December 2022. DesignThe study was performed on archived material of all patients who were referred to the fine needle aspiration clinic for cytology examination. Clinical and pathological data of cases were retrieved, and cases of BCG lymphadenitis were selected in the study based on these data. Slides of cases were retrieved, and cytological findings were studied. Materials and methodsPapanicolaou, Giemsa, and Hematoxylin & eosin-stained smears, as well as Ziehl-Neelson stain (Z.N. stain) smears of all BCG lymphadenitis cases, were retrieved. Cases were reviewed for individual cytological features and overall cytological diagnostic categories. Z.N. stain smears were evaluated for acid-fast bacilli. Results and conclusionsDiagnostic categories observed in BCG lymphadenitis include suppurative lymphadenitis/abscess (15 %), necrotizing lymphadenitis (23 %), necrotizing granulomatous lymphadenitis (46 %), suppurative granulomatous lymphadenitis (8 %), non-necrotizing granulomatous lymphadenitis (8 %). Acid-fast bacilli were detected by Z.N. stain in 8 cases (62 %).The cytological findings of BCG lymphadenitis closely overlap with those of tuberculous lymphadenitis. So, clinical context is very important while reporting isolated axillary lymphadenopathy, specifically in recently vaccinated infants, to avoid misdiagnosis as tuberculous lymphadenitis.

Implications of Axillary Lymphadenopathy Following COVID-19 Vaccination for Breast Cancer Screening

Aim: We conducted a systematic review to study cases of women who reported abnormalities on mammograms following COVID-19 vaccination, and evaluate the proportion of cases that warranted further investigations to rule out breast cancer. Through this, we aimed to evaluate the need for further follow-up radiological investigations such as sonography etc. before invasive investigations were carried out to rule out breast malignancy.
 
 Methods: Electronic Databases of PubMed, and Medline were searched on 18th July 2022, to extract published articles with the keywords: COVID-19 vaccination, Lymphadenopathy, and Mammogram. The publication timeframe of included studies ranged from November 01, 2019, to July 18, 2022. Studies that were published in languages other than English were not considered for this systematic review. In vitro studies, In vivo studies, review articles and short communications were not considered for this systematic review. However, references of reviews were cross-checked for relevant publications.
 
 Results: We identified 20 published results and 9 publications were selected after eliminating reviews, communication articles, and non-research articles 1048 patients were included in the systematic review. with 287 patients reporting significant abnormalities on mammography findings, which would warrant further invasive investigations according to NHS, UK protocols [9]

T-Cell-Rich Hodgkin Lymphoma With Features of Classic Hodgkin Lymphoma and Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Borderline Category With Overlapping Morphologic and Immunophenotypic Features.

It is known that a subset of cases of classic Hodgkin lymphoma (CHL) with B-cell-rich nodules (lymphocyte-rich CHL) exhibits morphologic and immunophenotypic features that overlap with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), raising diagnostic difficulties that can be resolved in most cases by performing an adequate battery of immunohistochemical studies. To fully characterize cases of T-cell-rich Hodgkin lymphoma where a specific diagnosis of NLPHL (ie, pattern D) or CHL could not be made even after complete immunophenotypic investigation. The clinical, immunomorphologic, and molecular (when applicable) presentation of 3 cases of T-cell-rich Hodgkin lymphoma was thoroughly investigated. These 3 cases harbored lymphocyte-predominant-like and Hodgkin and Reed-Sternberg-like cells that partially expressed B-cell and CHL markers and were negative for Tiftein-Barr virus-encoded small RNA, in a T-cell-rich background with residual follicular dendritic cell meshworks; 1 case had frequent and the other 2 cases scant/absent eosinophils and plasma cells. Two patients with advanced-stage (III or IV) disease presented with axillary and supraclavicular lymphadenopathy, respectively, and without B symptoms. These patients underwent NLPHL-like therapeutic management with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride [hydroxydaunorubicin], vincristine sulfate [Oncovin], and prednisone) chemotherapy; both are in complete remission 7 years posttherapy. One patient presented with stage I disease involving an internal mammary lymph node without B-symptoms and was treated with surgical excision alone; this patient is also in complete remission 1 year later. These cases illustrate overlapping features of T-cell-rich NLPHL and CHL with neoplastic cells expressing both B-cell program and CHL markers. This underrecognized overlap has not been fully illustrated in the literature, although it portrays a therapeutic challenge. These neoplasms may deserve in-depth investigation in the future that may bring up diagnostic or theragnostic implications.

Correlation between dynamic contrast-enhanced MRI characteristics and apparent diffusion coefficient with Ki-67-positive expression in non-mass enhancement of breast cancer

As a remarkably specific characteristic of breast cancer observed on magnetic resonance imaging (MRI), the association between the NME type breast cancer and prognosis, including Ki-67, necessitates comprehensive exploration. To investigate the correlation between dynamic contrast-enhanced MRI (DCE-MRI) characteristics and apparent diffusion coefficient (ADC) values with Ki-67-positive expression in NME type breast cancer. A total of 63 NME type breast cancer patients were retrospectively reviewed. Malignancies were confirmed by surgical pathology. All patients underwent DCE and diffusion-weighted imaging (DWI) before surgery. DCE-MRI characteristics, including tumor distribution, internal enhancement pattern, axillary adenopathy, and time-intensity curve types were observed. ADC values and lesion sizes were also measured. The correlation between these features and Ki-67 expression were assessed using Chi-square test, Fisher’s exact test, and Spearman rank analysis. The receiver operating characteristic curve and area under the curve (AUC) was used to evaluate the diagnostic performance of Ki-67-positive expression. Regional distribution, TIC type, and ipsilateral axillary lymph node enlargement were correlated with Ki-67-positive expression (χ2 = 0.397, 0.357, and 0.357, respectively; P < 0.01). ADC value and lesion size were positively correlated with Ki-67-positive expression (rs = 0.295, 0.392; P < 0.05). The optimal threshold values for lesion size and ADC value to assess Ki-67 expression were determined to be 5.05 (AUC = 0.759) cm and 0.403 × 10–3 s/mm2 (AUC = 0.695), respectively. The best diagnosis performance was the ADC combined with lesion size (AUC = 0.791). The ADC value, lesion size, regional distribution, and TIC type in NME type breast cancer were correlated with Ki-67-positive expression. These features will aid diagnosis and treatment of NME type breast cancer.

A case of ductal carcinoma in situ (DCIS) with markedly elevated CA15-3 levels requiring 2 years of diagnosis

BackgroundCA15-3 is often elevated in breast cancer recurrence and rarely in ductal carcinoma in situ (DCIS). We report a case of DCIS with elevated CA15-3 levels, which was diagnosed after over 2 years of follow-up.Case presentationA 74-year-old woman presented with a left-sided breast mass and pain. Redness, swelling, and induration were observed in the left breast. Ultrasonography revealed a non-mass lesion in the left 3 o'clock position, skin thickening, and axillary lymphadenopathy. Serum CA15-3 levels were markedly high at 640 U/mL, suggesting inflammatory breast cancer. However, biopsies showed no malignancy. We diagnosed chronic mastitis with elevated CA15-3 levels and followed up with magnetic resonance imaging and a biopsy, as needed. Finally, DCIS was diagnosed 27 months after the first visit. She underwent a left mastectomy and a sentinel lymph node biopsy; DCIS had spread 6.5 cm and was immunohistochemically positive for CA15-3. No metastasis was found in the lymph nodes, but incidental Hodgkin lymphoma was observed. Postoperative normalization of CA15-3 levels indicated that she had DCIS with elevated CA15-3 levels. The patient underwent chemotherapy for Hodgkin lymphoma postoperatively, and there was no evidence of recurrence 1 year after surgery.ConclusionHigh CA15-3 levels can also be observed in DCIS, indicating that CA15-3 should not be used solely in breast cancer staging.

21 An unusual case of axillary lymphadenopathy in an 85 year old man

21 An unusual case of axillary lymphadenopathy in an 85 year old man

Fat Embolism Syndrome from Bone Marrow Necrosis Following Peg-Filgrastim in a Patient with Primary Mediastinal B-Cell Lymphoma

Background: The mechanism of atraumatic fat embolization syndrome (FES) is poorly understood. However, mechanical and biochemical processes are the two plausible theories that exist. FES from bone marrow necrosis caused by hemoglobinopathies, use of chemotherapy in hematopoietic malignancies and from use of G-CSF has been reported. In our case, a young male patient with primary mediastinal large B-cell lymphoma presented with microhemorrhages and punctiform ischemic brain lesions after receiving chemoimmunotherapy and pegylated G-CSF. Case: A 29-year-old male recently diagnosed with primary mediastinal large B-cell lymphoma presented to our ED with severe bone pain after receiving his first cycle etoposide, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin, and rituximab (DA R-EPOCH) with peg-filgrastim support. He was discharged with pain control and subsequently received his second cycle of DA-R-EPOCH (20% increase in etoposide, doxorubicin, and cyclophosphamide) with a retrial of peg-filgrastim. His WBC count rose to a peak of 41,100K/UL on the seventh day of his second cycle. Ten days after receipt of his 2 nd peg-filgrastim, he presented to the ED with complaints of generalized weakness, decreased oral intake and mild imbalance with his gait. His blood pressure was 103/71 mmHg, heart rate was 138 beats per minute, respiratory rate was 22 breaths per minute and oxygen saturation was 91% on room air; and he required 2 liters of supplemental oxygen. Laboratory studies showed Hb of 8.1 gm/dL, PLT of 47,000k/UL and WBC of 10,100k/UL. The WBC differential was consistent with myeloid predominance with a left shift and some enucleated RBC consistent with use of peg- filgrastim. LDH was 2874 U/L, albumin was 3.8 g/L, PTT 23.1 seconds, PT 13.8 seconds, INR 1.2. A CT with angiography of the chest showed no pulmonary embolism but an anterior mediastinal soft tissue mass, which decreased in size compared to his prior image, with erosive changes of sternum. Mediastinal and axillary lymphadenopathy also overall decreased in size. Due to developing confusion and mild left-sided facial weakness, MRI with and without intravenous contrast of the brain demonstrated numerous petechial microhemorrhages throughout the brain parenchyma in the supratentorial compartment and posterior cranial fossa with involvement of superficial and deep parenchymal regions. Many were seen clustered in the internal/external watershed regions. Transthoracic echocardiogram with bubble study demonstrated a patent foramen ovale (PFO). Prophylactic low molecular weight heparin was started and he was discharged after improvement of symptoms. He proceeded to complete 4 more cycles of standard dose R-EPOCH with prophylactic levofloxacin instead of peg-GCSF. His neurologic symptoms resolved and did not recur. Conclusion: This case highlights a rare but severe complication of BMN causing fat embolization syndrome in a patient receiving G-CSF following R-EPOCH for high PMBCL with sternal bone involvement. We hypothesize that the rapid proliferation of myeloid cell lines induced by G-CSF led to vascular occlusion and relative hypoxemia. Furthermore, the prolonged incorporation of corticosteroids is known to cause adipose tissue disruption. His underlying disease involved invasion into his sternum which further would support the theory of bone marrow necrosis being able to dislodge into the vasculature. This case is important to alert physicians to be cognizant of this severe complication and to provide some evidence for continuing curative intent treatment with the omission of G-CSF support.

A Rare Case of CD1a +/CD207 + and S100 - Langerhans Cell Histiocytosis with Multi-System Risk Organ Involvement in Adult

Introduction: Langerhans Cell Histiocytosis (LCH) is a rare neoplastic disorder of myeloid dendritic cell precursors, leading to a spectrum of organ involvement and dysfunction. The nonspecific presentations result in missed or delayed diagnoses in adults, and data to guide the clinical care of adults with LCH is limited to case studies and series. Case Description: A 40-year-old Hispanic woman presented to the Emergency Department with ongoing symptoms of shortness of breath, muscle cramps, and intermittent chest pain for two weeks. She was found to have microcytic-hypochromic anemia requiring packed Red Blood Cells (pRBC) transfusion. A CT pulmonary angiogram showed incidental findings of splenomegaly and right axillary lymphadenopathy. A month before this presentation, she was evaluated for symptoms of polyuria, polydipsia, nocturia, and amenorrhea, ongoing for eight months. Arginine Vasopressin Deficiency (AVP-D) was diagnosed, and desmopressin was initiated. MRI Brain had revealed enhancement of the infundibular stalk. On follow-up in the clinic, an ultrasound of the right axilla showed a 2.4 cm lymph node (LN) with thickened cortex. Over the following month, she continued to require multiple pRBC transfusions. Further workup with Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) revealed hypermetabolic splenomegaly with multifocal uptake, including the right axilla suspicious for metastatic disease. ( Figure 1-A) A biopsy of the right axillary LN ( Figure 2 - A, B) showed clusters of Langerhans cells and immunohistochemistry positive for CD1a, CD3, CD20, CD68, keratin, and CD 207 (Langerin) staining and variable positivity for S100. Next-Generation Sequencing showed BRAF V600E missense mutation and NOTCH3, DICER1, CREBBP, JAK1, and CTNNA1 as Variants of Unknown Significance (VUS). Bone marrow (BM) aspirate and flow cytometry were unremarkable. A diagnosis of Multi-System LCH with Risk Organ Involvement (MS-RO +) was made. Cytarabine therapy was started at 150 mg/m 2(days 1-5, 28-day cycle). She was hospitalized twice due to sepsis, leukocytosis, severe anemia: Hemoglobin (Hb) 3.1, and grade 4 thrombocytopenia. Cycle 2 was delayed, and the dose was reduced to 50%. Post-infusions, Hb decline necessitated multiple pRBC transfusions. Repeat FDG-PET after cycles 2 and 5 ( Figure 1-B, C) showed continued metabolic and anatomic response to therapy. A repeat brain MRI showed no change in pituitary findings. The patient continues to improve clinically with plans to complete a total of one year of chemotherapy. Discussion: LCH is defined by the presence of CD1a +/CD207 + histiocytes. Although usually positive for S-100, rare S-100 negative variants have been reported in skin-limited LCH and LC-Sarcoma. An aberrant maturation process was proposed as a possible explanation, but the exact pathology remains unknown. In children &amp;lt;15 years, the incidence is 2.6-8.9 cases/million/year; in adults, the incidence is less defined at 0.07 cases/million/year and is higher in Hispanics. Adult LCH typically presents after the fourth decade; two-thirds have multi-system involvement. Hematopoietic dysfunction, cytopenias, and liver involvement carry a poor prognosis. AVP-D is the most frequently associated endocrine abnormality. Whole-exome sequencing has shown very low somatic mutation frequency in LCH compared to other neoplastic disorders. BRAF, a central kinase in the RAS-RAF-MEK pathway, has a missense V600E mutation in roughly 50% of LCH, rendering it constitutionally active. Other mutations include BRAF, MAP2K1, ARAF, ERBB3, NRAS, and KRAS, but the VUS mentioned above have been reported infrequently. The LCH-III trial confirmed Vinblastine/Prednisone as the standard regimen for MS-LCH patients &amp;lt;18 years, with or without RO involvement. While it is effective in adults, its limited tolerance favors the use of cytarabine or cladribine. NCT02670707 is an ongoing trial comparing cytarabine monotherapy versus Vinblastine/Prednisone for frontline treatment. BRAF inhibitors are also being increasingly investigated. Prospective trials to optimize the duration of therapy (LCH-IV) and potential combination therapies are currently underway.

NIMG-89. CNS-ISOLATED RICHTER’S TRANSFORMATION: THE FALLIBILITY OF NEURO-IMAGING AND THE CRITICAL ROLE OF BRAIN BIOPSY IN A CHALLENGING DIAGNOSIS

Abstract INTRODUCTION An 81-year-old male was admitted for acute encephalopathy and failure to thrive. Workup revealed a lymphocyte-predominant leukocytosis, prominent axillary and mediastinal lymphadenopathy on CT, and multiple supra-tentorial FLAIR-hyperintense lesions that were homogenously contrast-enhancing. Axillary lymph node biopsy demonstrated small lymphocytic lymphoma (SLL), a variant of CLL. Despite concern for CNS malignancy, brain biopsy was initially deferred since the patient’s brain lesions were attributed to SLL metastasis. However on hospital day 15, he developed partial seizures, prompting stereotactic biopsy which revealed DLBCL. DATA/DISCUSSION Our case highlights the pitfalls of relying solely upon neuro-imaging to diagnose Richter’s transformation (RT) isolated to the CNS. First, MRI does not differentiate CNS metastasis of systemic lymphoma from CNS RT. A review of 35 biopsy or LP-proven cases of CNS-isolated RT showed imaging characteristics consistent with primary and metastatic CNS lymphoma. When parenchymal lesions are present, all are T2/FLAIR hyper-intense; 60% are unifocal (40% multifocal); and 95% homogenously enhance. Second, CNS-isolated RT is at least 3 times rarer than CNS metastases of CLL. Among patients with CLL, ~1% will eventually exhibit CNS metastasis but &amp;lt; 0.3% will develop CNS-isolated RT. In patients with known CLL and no evidence of high-grade transformation, it is reasonable to attribute brain lesions to CNS metastasis of CLL as opposed to RT, absent a definitive tissue diagnosis. CONCLUSION These data emphasize the importance of biopsy in the workup of CNS lymphoma, especially since treatment differs based on histopathological subtype. Given its chronic indolent course, SLL is typically managed expectantly, whereas the aggressive nature of DLBCL warrants more intensive chemotherapy. Our case also shows that in patients with suspicious CNS lesions, presence of systemic malignancy does not eliminate the need for brain biopsy, and that clinical deterioration should prompt biopsy if not already performed.

Histoplasmose africaine chez un enfant en Guinee: a propos d’un cas

African histoplasmosis is a rare deep mycosis caused by two varieties of Histoplasma capsulatum (capsulatum and duboisii). We report a case of histoplasmosis in an immunocompetent child. 6-year-old female patient, hospitalized for poor general condition, fluctuating inflammatory swelling of the lower limb evolving for 4 months. The clinical examination revealed in an altered and febrile patient, papulo-nodular lesions of variable size, fluctuating in places, disseminated umbilical predominantly on the trunk, the root of the upper and lower limbs. There were also axillary and inguinal lymphadenopathy and osteo-articular involvement. X-ray of the right lower limb revealed osteomyelitis. Histopathology of the biopsied nodule confirmed African histoplasmosis. The rarity of African histoplasmosis in our country corroborates current data from the literature, however this could also be due to an underdiagnosis often influenced by self-medication.

Cutaneous Metastasis as a Diagnostic Prelude in a 48-year-old Female

Abstract Cutaneous metastasis (CM) describes the spread of a distant primary tumor into the skin. The overall incidence of CM ranges from 5% to 10% with breast cancer having the highest rate in women. CM of breast carcinoma origin may manifest as erysipelas-like erythema on the chest, having distinct raised borders and edema due to lymphatic obstruction termed as carcinoma erysipeloides. In most cases, CM is recognized after the initial diagnosis of primary internal malignancy. However, in 0.6–1% of cases, CM served as the first presenting sign of malignancy. A 48-year-old female presented with multiple, erythematous patches, and plaques with clear-cut raised margins, some topped with violaceous pinpoint papules and nodules on the chest, abdomen, and back. No palpable breast mass was appreciated. There was noted nipple retraction and axillary lymphadenopathy. A 4-mm skin punch biopsy revealed nests of large pleomorphic cells on the papillary dermis admixed with mitotic figures and attempts of ductal formation. CK7 and CEA were positive. Results of ultrasonography and mammogram were highly suspicious of malignancy. Core needle biopsy of the breast mass revealed an invasive ductal carcinoma. In the context of an eczematous presentation on the chest area without palpable nodules or mass on breast examination, a diagnostic challenge is expected. Interestingly, our patient represents a small group of CM having cutaneous lesions as their primary manifestation. A high index of suspicion supplemented with proper clinicopathologic and radiologic correlation is crucial for the diagnosis of CM. A multidisciplinary referral is required for adequate management and overall survival rate.

Shoulder Effusion as Ultrasound Mimic of Axillary Lymphadenopathy

Shoulder Effusion as Ultrasound Mimic of Axillary Lymphadenopathy

Axillary silicone lymphadenopathy caused by gel bleeding with intact silicone breast implants: a case report

Gel bleeding following breast augmentation using silicone breast implants (SBIs) occurs when microscopic silicone droplets diffuse through the implant surface, potentially resulting in complications such as capsular contracture and immune responses related to breast implant illness. Prompt and reliable diagnostic measures are crucial, as the presentation of gel bleeding can resemble cancer, making an accurate diagnosis challenging. This report discusses a rare case of axillary silicone lymphadenopathy caused by gel bleeding in a 48-year-old woman with intact SBIs. Silicone lymphadenopathy can be suspected based on mammography, ultrasonography, and magnetic resonance imaging in patients with a history of SBI insertion, and confirmation can be obtained through a pathological examination. Excisional biopsy is generally recommended for symptomatic patients, while treatment may not be necessary for asymptomatic patients; However, removal can be considered if the patient indicates a preference for it. Patients with silicone lymphadenopathy require replacement of SBIs to examine the breast capsule and verify the integrity of the implant. This case highlights the importance of considering gel bleeding as a potential cause of silicone lymphadenopathy, even in patients with intact SBIs.

Survey on Management of Unilateral Axillary Lymphadenopathy after Recent Ipsilateral COVID-19 Vaccination

Survey on Management of Unilateral Axillary Lymphadenopathy after Recent Ipsilateral COVID-19 Vaccination

Breast cancer metastasis patterns in Yenagoa, Nigeria

Objectives: The objective of this study was to study the characteristics and patterns of metastatic breast cancer in Yenagoa, Nigeria. Material and Methods: This study was a retrospective hospital-based study using a standardized data form for the capture of relevant information with definite exclusion criteria. Information gathered was captured in an Excel spreadsheet and subjected to statistical analysis. Subjects were 78 female patients diagnosed with breast cancer. Results: The mean age of the study population was 47.86 years. About 64% had 1–4 children while 26% had more than five children. The most common findings on general clinical examination were anemia (43.6%), cachexia (39.7%), and hepatomegaly (11.5%). On breast examination, the most common findings were axillary lymphadenopathy (87.2%), nipple changes (67.9%), peau d’orange (64.1%), skin nodules (64.1%), and chest fixity (60.3%). About 29.5% of patients had evidence of pulmonary metastasis, 19.2% had liver metastases, and 25.6% had spread to multiple sites. Central nervous system and spinal spread were found to be commoner in younger patients (&lt;48 years). Conclusion: Most of the patients presenting in the hospital had evidence of metastasis. This has been found to be due mostly to delay in hospital presentation due to a complex combination of patient and healthcare-related factors. Measures for improving the dire statistics are proffered.

Clinical and laboratory features associated with macrophage activation syndrome in Still’s disease: data from the international AIDA Network Still’s Disease Registry

To characterize clinical and laboratory signs of patients with Still’s disease experiencing macrophage activation syndrome (MAS) and identify factors associated with MAS development. Patients with Still’s disease classified according to internationally accepted criteria were enrolled in the AutoInflammatory Disease Alliance (AIDA) Still’s Disease Registry. Clinical and laboratory features observed during the inflammatory attack complicated by MAS were included in univariate and multivariate logistic regression analysis to identify factors associated to MAS development. A total of 414 patients with Still’s disease were included; 39 (9.4%) of them developed MAS during clinical history. At univariate analyses, the following variables were significantly associated with MAS: classification of arthritis based on the number of joints involved (p = 0.003), liver involvement (p = 0.04), hepatomegaly (p = 0.02), hepatic failure (p = 0.01), axillary lymphadenopathy (p = 0.04), pneumonia (p = 0.03), acute respiratory distress syndrome (p < 0.001), platelet abnormalities (p < 0.001), high serum ferritin levels (p = 0.009), abnormal liver function tests (p = 0.009), hypoalbuminemia (p = 0.002), increased LDH (p = 0.001), and LDH serum levels (p < 0.001). At multivariate analysis, hepatomegaly (OR 8.7, 95% CI 1.9–52.6, p = 0.007) and monoarthritis (OR 15.8, 95% CI 2.9–97.1, p = 0.001), were directly associated with MAS, while the decade of life at Still’s disease onset (OR 0.6, 95% CI 0.4–0.9, p = 0.045), a normal platelet count (OR 0.1, 95% CI 0.01–0.8, p = 0.034) or thrombocytosis (OR 0.01, 95% CI 0.0–0.2, p = 0.008) resulted to be protective. Clinical and laboratory factors associated with MAS development have been identified in a large cohort of patients based on real-life data.

Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Lymphoma with Isolated Hepatic Presentation.

Differential diagnosis of fever, especially in young patients, is very complex and complete investigation takes time, which can delay the diagnosis of malignancies such as primary hepatic lymphoma (PHL).PHL is very rare, and overlapping symptoms with other liver diseases can make the diagnosis very challenging.When the suspicion of PHL is very high, only the hepatic biopsy can lead to the correct diagnosis because the disease has no extrahepatic involvement.

Radiological characteristics of invasive micropapillary carcinoma of the breast

To analyse the various imaging features of invasive micropapillary carcinoma (IMPC), a distinct variant of breast cancer, by mammography, ultrasound, and contrast-enhanced mammography. This study included 68 female patients with histopathologically proven invasive micropapillary carcinoma who underwent mammography, ultrasound, and contrast-enhanced mammography examinations. The findings encountered by each imaging tool were analysed using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. In this retrospective study, 64.7% of cases were of the pure form of IMPC. Most of the cases showed an aggressive clinical course, with lymphovascular invasion noted in 76.5% of cases, while 60.3% of cases showed associated pathological lymphadenopathy. The N3 stage was reported in 25% of cases. On analysing the mammographic and ultrasound imaging findings, a significant association between irregular shape and a non-circumscribed margin with IMPC was found. Associated calcification was noted in 47% of cases. Pathological enhancement of moderate or marked conspicuity was noted in cases that underwent contrast-enhanced mammography, with the most commonly encountered finding being enhancing irregular and non-circumscribed masses. The mammographic and ultrasound imaging features of IMPC are indistinguishable from other aggressive types of breast cancer. At contrast-enhanced mammography examination, pathological enhancement of moderate to marked conspicuity was shown in all cases. The observed strong association of IMPC with lymphovascular invasion and lymph node metastasis with higher nodal stage in this study mandate meticulous sonographic examination of the axilla, as well as the infra, and supraclavicular regions if pathological axillary lymphadenopathy was noted.

Computed Tomography Imaging of COVID-19 Vaccination–related Axillary Lymphadenopathy: Updated Review of Literature

As of September 2022, approximately 606 million cases of COVID-19 have been reported and 6.5 million deaths have occurred worldwide [1]. COVID-19 vaccination programs are in progress around the world to control the pandemic [2]. Till September 2022 approximately 12.6 billion doses of the vaccine have been globally administered [3]. It has been found that reactive hyperplasia of the ipsilateral axillary nodes and sometimes contralateral node is a side effect of vaccination [4]. The frequency of imaging-detected lymphadenopathy ranged between 14.5 to 53% [5]. Cancer patients undergoing active treatment or follow-up surveillance undergo frequent cross-sectional imaging which incidentally detects vaccine-related lymphadenopathy. A Chest CT scan is the most used imaging modality for lung cancer monitoring and lung screening for metastasis of other malignancies. Thus, incidentally detected COVID-19-associated axillary lymph node enlargement is seen in these patients who undergo frequent chest CT scans including the axilla. It is difficult to differentiate lymph node enlargement due to Covid vaccination from lymph node metastasis on imaging. This can lead to unnecessary fine needle aspiration cytology or biopsy thus increasing the patient’s cost and public health burden [6][7][8]. This systematic review aims to evaluate the published literature evidence of axillary lymphadenopathy after COVID-19 vaccination and its imaging features on Chest CT.

Tuberculosis in Superficial Lymphadenopathy Based on Fine Needle Aspiration Cytology: A Cross Sectional Study

Objective: To investigate the prevalence of tuberculosis among individuals presenting with superficial lymphadenopathy using Fine Needle Aspiration Cytology (FNAC) as a diagnostic method. Methodology: This cross-sectional research spanned three years, conducted at HBS General Hospital in Islamabad from July 2016 to June 2019. The study enrolled individuals meeting specified inclusion and exclusion criteria, presenting with superficial lymph node enlargement. All participants provided written consent before undergoing fine needle aspiration cytology (FNAC), and the diagnosis of tuberculosis relied on histopathological findings. Results: Among 632 patients aged 15 to 60 years who underwent FNAC following clinical examination and relevant lab investigations, 85.4% (n=540) exhibited cervical lymphadenopathy. Among these, 57.7% (n=312) were diagnosed with tuberculous lymphadenitis, comprising 58.3% females (n=182) and 41.6% males (n=130). Axillary lymphadenopathy was observed in 5.53% (n=35) of patients, among whom 3.64% females (n=23) and 2.1% males (n=13) were diagnosed with tuberculous lymphadenopathy. Generalized lymphadenopathy was seen in 5.1% (n=32) of cases, with 0.94% males (n=6) and 0.79% (n=5) demonstrating histological evidence of TB on FNAC. Inguinal lymphadenopathy was observed in 3.95% (n=25) of patients, including 0.94% males (n=5) and 0.47% females (n=3). Conclusion: Lymphadenopathy, a prevalent clinical condition, encompasses various underlying causes, ranging from manageable tuberculosis to malignant conditions. FNAC serves as a safe and rapid diagnostic technique, reducing the need for excisional biopsies. In this study, cervical lymph nodes were most frequently affected by tuberculous lymphadenopathy, particularly among females.