Axillary Lymph Node Enlargement Research Articles

Prediction value study of breast cancer tumor infiltrating lymphocyte levels based on ultrasound imaging radiomics.

Construct models based on grayscale ultrasound and radiomics and compare the efficacy of different models in preoperatively predicting the level of tumor-infiltrating lymphocytes in breast cancer. This study retrospectively collected clinical data and preoperative ultrasound images from 185 breast cancer patients confirmed by surgical pathology. Patients were randomly divided into a training set (n=111) and a testing set (n=74) using a 6:4 ratio. Based on a 10% threshold for tumor-infiltrating lymphocytes (TIL) levels, patients were classified into low-level and high-level groups. Radiomic features were extracted and selected using the training set. The evaluation included assessing the relationship between TIL levels and both radiomic features and grayscale ultrasound features. Subsequently, grayscale ultrasound models, radiomic models, and nomograms combining radiomics score (Rad-score) and grayscale ultrasound features were established. The predictive performance of different models was evaluated through receiver operating characteristic (ROC) analysis. Calibration curves assessed the fit of the nomograms, and decision curve analysis (DCA) evaluated the clinical effectiveness of the models. Univariate analyses and multivariate logistic regression analyses revealed that indistinct margin (P<0.001, Odds Ratio [OR]=0.214, 95% Confidence Interval [CI]: 0.103-1.026), posterior acoustic enhancement (P=0.027, OR=2.585, 95% CI: 1.116-5.987), and ipsilateral axillary lymph node enlargement (P=0.001, OR=4.214, 95% CI: 1.798-9.875) were independent predictive factors for high levels of TIL in breast cancer. In comparison to grayscale ultrasound model (Training set: Area under curve [AUC] 0.795; Testing set: AUC 0.720) and radiomics model (Training set: AUC 0.803; Testing set: AUC 0.759), the nomogram demonstrated superior discriminative ability on both the training (AUC 0.884) and testing (AUC 0.820) datasets. Calibration curves indicated high consistency between the nomogram model's predicted probability of breast cancer TIL levels and the actual occurrence probability. DCA revealed that the radiomics model and the nomogram model achieved higher clinical net benefits compared to the grayscale ultrasound model. The nomogram based on preoperative ultrasound radiomics features exhibits robust predictive capacity for the non-invasive evaluation of breast cancer TIL levels, potentially providing a significant basis for individualized treatment decisions in breast cancer.

Abstract PO5-20-06: Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma

Abstract Paraneoplastic cerebellar degeneration (PCD) in the context of breast carcinoma affects less than 1% of patients. In most cases, breast cancer diagnosis follows several months or even years after the onset of neurological symptoms. The first association between PCD and occult gynecologic cancers (breast or ovarian) was identified in 1938 with the discovery of antibodies directed against cytoplasmic antigens of Purkinje cells (“anti-Yo antibodies”). Since then, evidence has grown significantly to support anti-Yo antibodies as excellent diagnostic markers of PCD with underlying gynecologic and breast carcinoma. This case study evaluates a 57-year-old female who initially presented with headache and subacute cerebellar ataxia. Her symptoms progressed over a period of three months with multiple falls, onset of speech difficulties, and diplopia. She also reported 30-pound weight loss, which she attributed to dieting and starting semaglutide. Magnetic resonance imaging (MRI) of the brain and spine were unremarkable and autoimmune workup was normal. Cerebral spinal fluid (CSF) and serum studies demonstrated positive anti-Yo antibodies. Computed tomography (CT) of the abdomen and pelvis showed an enlarged left axillary lymph node concerning for metastatic disease with a 1.2cm focus of asymmetric density in the central inferior left breast parenchyma. Diagnostic mammogram one year prior was reportedly normal. Ataxia symptoms improved after a course of empiric intravenous immunoglobulins and steroids. Ultrasound-guided biopsy of the left axillary lymph node revealed metastatic mammary carcinoma: estrogen and progesterone receptor negative and human epidermal growth factor receptor 2 (HER2)-positive, cT0N2aM0, ypTxN1aM0, stage IIIa (AJCC 8th edition). She underwent further metastatic workup, including repeat CSF studies and MRI. MRI of the spine was remarkable for multiple hemangiomas throughout the cervical, thoracic, and lumbar spine, with subsequent unremarkable bone scan. MRI of the abdomen was remarkable for right hepatic lobe hemangioma and a right adrenal nodule. CSF studies showed no sign of metastases. After multidisciplinary discussion, TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) neoadjuvant therapy was initiated and repeat imaging demonstrated favorable treatment response with a shrinking axillary mass; no primary breast mass was identified. The patient underwent left sentinel lymph node biopsy with a positive frozen section intraoperative for invasive cancer, therefore proceeded with left axillary lymph node dissection. She was offered a mastectomy but elected for only axillary surgery. Pathology revealed 1 of 14 lymph nodes were positive for metastatic ductal carcinoma. She remains in a rehabilitation center and her ataxia is improving, but her functional status remains below baseline. She is undergoing radiation to whole breast and regional lymph nodes. With this case, we aim to continue to build upon the limited base of the exceedingly rare presentation of breast cancer-associated paraneoplastic syndrome. In addition, several studies and case reports have demonstrated a strong correlation between HER2 overexpression and anti-Yo associated PCD. As we continue to diagnose and monitor breast cancer patients, we could consider starting to screen for anti-Yo antibodies in HER2-positive patients to gain insight into a patient’s prognosis and development of PCD. Citation Format: You Kim, Alison Coogan, Andrea Madrigrano. Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-06.

OA14 Subcutaneous panniculitis-like T-cell lymphoma: a mimic of lupus erythematous panniculitis

Abstract Background/Aims Lupus erythematosus panniculitis (LEP) is a rare variant of cutaneous lupus erythematosus characterised by tender, erythematous subcutaneous nodules or plaques on the face, trunk and proximal extremities. Without treatment, profound lipoatrophy frequently occurs, which often has a devastating psychosocial impact. Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cutaneous T-cell lymphoma, which may appear in a similar manner. SPTCL initially preferentially infiltrates the subcutaneous adipose tissue and symptoms vary widely depending on the stage of the disease. Early-stage disease presents as painless self-resolving subcutaneous nodules on limbs and trunk. Methods We present the case of a young woman who presented with progressively developing, widespread painful cutaneous lesions, pyrexia of unknown origin and general malaise for one month. She had a history of hurthle cell neoplasm and a strong family history of malignancy. Initial examination revealed 1-2 cm firm, skin-coloured subcutaneous nodules over her lower back, chest and thigh, with groin and axillary lymphadenopathy. Further lesions progressively developed over a three-month period, with lesions turning increasingly erythematous and with associated ulceration. Of note, a significant periorbital lesion appeared, associated with an ipsilateral facial palsy. Results Initial bloods revealed an elevated LDH with cholestatic liver function tests. PET-CT imaging showed an enlarged axillary node with extensive pathology throughout the subcutaneous fat of unknown aetiology. Due to the family history, underlying haematological malignancy and atypical Sweet’s were considered for this unusual presentation. Seropositivity for anti-Ro and ENA, alongside raised angiotensin converting enzyme, broadened the differentials to include LEP, mixed atypical connective tissue disease and cutaneous sarcoid. Notably, complement, myositis panel and creatine kinase were normal. Lupus vulgaris was considered due to high local prevalence and excluded with T-SPOT testing. Histopathological analysis of lesional skin from the upper arm found predominantly subcutaneous infiltrates of atypical lymphoid cells with irregular hyperchromatic nuclei and rimming of individual fat cells. T-cell clonality analysis detected clonal T-cell receptor beta (V-J and D-J) gene rearrangements consistent with SPTCL. Her orbital and cutaneous lesions responded well to six cycles of CHOEP (cyclophosphamide, hydroxydaunorubicin, oncovin, etoposide, prednisone) and the patient returned to functional baseline. Conclusion This case demonstrates the diagnostic difficulties when managing a patient with relapsing remitting panniculitis. Whilst the initial presentation of SPTCL here was classical, with widespread multifocal subcutaneous nodules, the appearance of facial symptoms in SPTCL is rare. Diagnostic uncertainty is frequent in both LEP and SPTCL due to the initial non-specific cutaneous presentation. This case emphasises the importance of clinicopathological correlation for accurate diagnosis. Interestingly, up to 20% of SPTCL patients have concomitant autoimmune diseases, and there is evidence suggesting a potential association between LEP and subcutaneous SPTCL beyond chance, leading some researchers to propose that these two entities exist along a spectrum. Disclosure D. Li: None. L. Spencer: None.

A Rare Case of Multicentric Reticulohistiocytosis in An Elderly Male Patient

Multicentric reticulohistiocytosis (MRH) is a rare systemic proliferative granulomatous disease of non-Langerhans cells. The aim of this study is to report a case of multicentric reticulohistiocytosis that is easily misdiagnosed in clinical practice. A 74-year-old man sought the Rheumatology office in December 2022 with a main complaint of arthralgia for six months, associated with morning stiffness, joint swelling, and upper and lower limb weakness. On physical examination, papules on the dorsal surface of the proximal interphalangeal joints, base of the nose, and lateral surface of the right hallux were observed. Hyperemia was also identified on the back, and edema of the proximal and distal interphalangeal joints, wrists and knees. Laboratory tests revealed ESR and ANA within normal limits. Tests were negative for Anti-Sm, Anti-RO, rheumatoid factor, Anti-CCP, HIV, and HCV. Chest CT-scan showed right axillary lymph node enlargement, measuring 2.7 cm, atheromatous aorta, and streaks with scattered atelectasis in the lower lobe, without other changes. On total abdominal ultrasound, prostate enlargement was detected. Immunohistochemistry of skin biopsy identified atypical acinar proliferation. Histopathology skin biopsy stained with hematoxylin-eosin (January 2023) showed a dense histiocytic infiltrate. Detail of the histiocytic component displayed “ground glass” eosinophilic cytoplasm. Immunohistochemistry was negative for S100 and CD34 and positive for CD68. Final diagnosis was MRH. The patient underwent treatment with drugs. In conclusion, clinical manifestations, including skin and joint changes, with signs and symptoms of rheumatic disorders (e.g. dermatomyositis and rheumatoid arthritis) similar to those of MRH are expected in rheumatology practice. However, knowledge about disease progression in MRH is limited. Therefore, this case report is described due to its rarity Keywords: Non-Langerhans-Cell Histiocytosis, Pathology, Muticentric Reticulohistiocytosis, Rheumatological Diseases,

Factors Impacting the Staging of Breast Cancer: A Cross-Sectional Study

Breast cancer remains a significant public health concern, with staging at diagnosis being a critical factor in prognosis and treatment planning. While biomedical markers have been extensively studied, there is a growing interest in understanding the diagnostic impact of various factors on the staging of breast cancer. This cross-sectional study was conducted on 50 patients with diagnosed breast cancer, further stratifying them by stage (I-IV) and correlating with different factors which includes socio demographic factors too. A significant association was found between the less than &lt;12 years of age of menarche (p-value 0.038), more than one children (p value 0.014) and no breast feeding history (p-value 0.05) with advanced cancer stage (stage IV). No significant association was observed among age of menopause, marital status with cancer staging. Among the clinical features of respondents, the size of the breast lump, presence of nipple retraction, and axillary lymph node enlargement were found more with stage IV. The findings suggested that while certain social factors like marital status may not directly influence the stage at diagnosis, the number of children a patient has could be an indicator of later-stage diagnosis. About 40% of respondents were diagnosed at stage IV, followed by 28% at stage III, indicating a trend towards late diagnosis. This may reflect broader societal and behavioural patterns that affect health-seeking behaviour and access to healthcare. The staging of breast cancer based on these clinical features not only guides the therapeutic approach, including the decision for surgery, chemotherapy, and radiation therapy, but also has implications for the patient's survival outcomes. Understanding these associations aids clinicians in developing personalized treatment plans and also plays a role in the development of screening guidelines aimed at early detection.

Analysis of clinical factors and ultrasound features associated with COVID-19 vaccine-related axillary lymphadenopathy: A large group study

PurposeTo investigate factors that distinguish COVID-19 vaccine-related axillary lymphadenopathy from malignancy or other etiologies. MethodsFrom June 2021 to April 2022, 3859 consecutive female patients had breast and axillary ultrasound (US) at our institution. After exclusions, 592 patients were included in the study. We retrospectively reviewed clinical history and US features of enlarged axillary lymph nodes. Assessed clinical factors included age, vaccination type, dose and vaccination date, and ultrasound features included cortical thickness, shape, marginal irregularity, focal cortical thickening, fatty hilum, and number and anatomic location of enlarged lymph nodes. The seven US features were used to score the severity of lymphadenopathy. Binary logistic models and independent two-sample t-tests were used for statistical analysis. ResultsAmong 592 patients (mean age 49.3 ± 10.3 years), 406(68.6%), 90(15.2%), 42(7.1), 4(0.7%) and 50(8.4%) patients received Pfizer, AstraZeneca, Moderna, Janssen and cross inoculation of more than one type, respectively. 185(31.3%), 376(63.5%) and 31(5.2%) patients received a first, second and third dose, respectively. The interval between vaccination and US was 30.9 ± 21.5 days. US showed axillary lymphadenopathy (LAP) in 113 patients (19.1%). Clinical factors associated with LAP were age younger than 50 years, mRNA vaccine, first dose and shorter interval(P < 0.05). US features associated with LAP were mean cortical thickness of 4.6 ± 1.63 mm, oval shape (70.8%), smooth margin (53.1%), focal cortical thickening (62.8%) and preserved fatty hilum (84.1%). Using our scoring method, the mean overall score for vaccine-related LAP was 2.45 ± 1.51 points. ConclusionAwareness of influencing factors and sonographic features can help differentiate COVID-19 vaccine-related adenopathy from other etiologies.

Sonographic Characteristics of Enlarged Axillary Lymph Node in Breast Cancer

Background: Breast cancer, the most prevalent cancer in women globally, presents unique challenges in Pakistan, particularly due to the younger average age of diagnosis compared to Western countries. Accurate assessment of axillary lymph nodes using ultrasound (US) is essential for effective breast cancer staging and prognosis. Objective: This study aimed to evaluate the sonographic characteristics of axillary lymph nodes in breast cancer patients in Pakistan and to assess the diagnostic efficacy of ultrasound in differentiating between benign and malignant lymph nodes. Methods: Conducted at Shalamar Hospital, Lahore, this cross-sectional study spanned four months and included 150 breast cancer patients aged 45-70 years, selected through convenient sampling. Ultrasound examinations were performed using a GE Ultrasound Machine Evolsion E7 with a linear probe (7.5-12Hz). Key sonographic parameters, including the shape, size (length and width), and echogenicity of lymph nodes, were meticulously recorded and analyzed by using SPSS 24.0. Results: The average length and width of lymph nodes were 5.86 mm (SD = 1.35) and 3.90 mm (SD = 0.77), respectively. A significant proportion of lymph nodes (74.2%) presented with a round shape in patients experiencing pain, and a predominance of hyperechoic nodes was noted, diverging from established literature that often associates hypoechoic nodes with malignancy. Additionally, an irregular shape was identified as a potential predictive marker for axillary lymph node metastasis. Conclusion: This study highlights the efficacy of axillary sonography in diagnosing axillary metastasis in breast cancer, showing moderate sensitivity and substantial specificity. It also identifies a notable association between older age and the likelihood of axillary lymph node metastasis, especially in women in their forties.

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.

POEMS-associated Multicentric Castleman Disease: A diagnostic and Therapeutic Conundrum

Abstract Introduction/Objective A rare multisystemic, paraneoplastic hematologic disorder, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is associated with an overproduction of pro-inflammatory cytokines caused by a plasma cell proliferative disorder. Castleman disease is a rare clinical entity described as a polyclonal lymphoid proliferation, that leads to generalized lymphadenopathy. It is rarely presented in association with POEMS Syndrome. Methods/Case Report A 55-year-old hispanic male, when being evaluated for liver mass, revealed bile duct thickening and a pancreatic head mass. Endoscopic fine needle aspiration biopsies were negative; however, the cross sectional imaging identified enlarged left axillary lymph nodes. His excisional lymph node biopsy showed human herpese virus-8 (HHV-8) negative multicentric Castleman disease (MCD). Several features of POEMS syndrome were noted. The axillary lymph node biopsy demonstrated florid follicular hyperplasia, scattered regressed germinal centers and concentric rings of mantle zone lymphocytes. CD138, kappa-ISH, and lambda-ISH highlight scattered polytypic plasma cells. Our case fulfills the mandatory criteria of POEMS syndrome with the presence of neuropathy and a constellation of other major and minor criterion including, axillary Castleman, splenomegaly, hepatomegaly, skin changes, ascites and bilateral renal cortical lesions. Furthermore the patient also has a history of cerebrovascular accident and chronic cough favoring POEMS syndrome. Results (if a Case Study enter NA) NA Conclusion The complexity and multi-organ involvement, leads to frequent misdiagnosis of POEMS disease. In addition significant overlap of symptoms of POEMS syndrome makes it difficult to differentiate from other plasma cell disorders associated with MCD. Our study includes a brief review of the literature delineating the characteristics and overlap between POEMS syndrome and other diseases.

Dedifferentiated endometrial carcinoma metastasis to axillary lymph node: a case report

BackgroundWe present an unusual case of a left axillary lymph node metastasis from a primary dedifferentiated endometrial carcinoma. This pattern of metastasis is likely the result of circulating tumor cells reaching the node through its arterial blood supply.Case presentationIn this report, a 68-year-old white woman with a dedifferentiated endometrial carcinoma underwent a hysterectomy. She later developed an enlarged axillary lymph node due to metastatic dedifferentiated endometrial carcinoma, treated with chemotherapy and anti-programmed cell death protein 1 immunotherapy resulting in a complete clinical and radiological response.ConclusionA review of the literature reveals the rarity of blood-borne lymph node metastasis, especially with uterine carcinoma. Immunotherapy has shown promising results in the treatment of some subtypes of metastatic uterine carcinoma.

Accessory Breast Cancer of the Right Axillary Region: A Case Report and Review of Management

Accessory breast tissue results from failure of the embryologic mammary ridge, also known as the milk line, to involute. Because of the low incidence of these cases in the population and the lack of a fixed location for the tumor to occur. Case Presentation: Here we present a female patient, 51 years old, who was born with a swelling on the side of the arm in the right axilla that grew with age. Three years ago, a lump the size of an egg was found protruding from the body and gradually ulcerating. Conclusion: Ultrasound assisted examination revealed that the patient had right axillary lymph node enlargement and Pathological diagnosis of accessory breast cancer. The early stage of accessory breast cancer mostly presents only as a painless mass. Therefore, when an abnormality is detected in the early stage, it should be checked out promptly to avoid deterioration.

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.

Acute Lymphoblastic Leukemia in Pregnancy: Pregnant Woman Battled Against Leukemia Until 36 Weeks of Gestation: A Case Report

Leukemia in pregnancy is uncommon and may be a fatal condition. Using chemotherapy treatment during pregnancy gives adversity to the mother and fetus, resulting in a dilemma about the proper management plan. A 33-year-old pregnant woman who is G3P2L2 presented at 22 weeks of gestation with on-and-off back pain and progressive pancytopenia. During this admission, she was suspected to have mild pericarditis, yet the echo report was normal. Clinically, she had small multiple axillary lymph node enlargement, and abdominal ultrasound showed mild hepatosplenomegaly. Diagnosis of pre-B acute lymphoblastic leukemia (pre-B ALL) was confirmed by bone marrow biopsy. She was treated with UK-ALL protocol chemotherapeutic regimen (Table 1), considering some modifications in the standard protocol due to pregnancy. She delivered a healthy boy by loweruterinesegment cesarean section at 36 weeks of gestation. She was encouraged to breastfeed her baby for only 2 weeks in order to pursue chemotherapy treatment afterward. Chemotherapy management during pregnancy carries more risks to both the mother and the fetus and is more challenging to clinicians; therefore, clinicians need to be aware of early diagnosis of leukemia and have high suspicion, especially during pregnancy.

Isolated Myelopathy in Occult Breast Carcinoma with Negative Paraneoplastic Antibodies: A Case Report of a Rare Condition

Isolated paraneoplastic myelopathy (IPM) is a rare neurological manifestation of systemic cancer and represents an intermediate-risk phenotype of disease according to the diagnostic criteria for Paraneoplastic Neurologic Syndromes (PNS). Here, we present the case of a 47-year-old woman who developed subacute cervical myelopathy and was then diagnosed with breast cancer. Through this lens, we provide a discussion of current literature on IPM. Over four months, our patient developed progressive tetraparesis, hypoesthesia with C3 level, and urinary retention. The first MRI was negative, but a four-month-control MRI showed a T2-hyperintense spinal lesion (C2–C7 and T2–T4). Cerebrospinal fluid (CSF) analysis was normal. Infective and autoimmune screening, including onconeural, anti-MOG, and aquaporin-4 antibodies, was unremarkable. The total-body CT scan was negative, but total-body PET-CT scan evidenced an enlarged axillary lymph node, with the detection of breast cancer cells at fine-needle aspiration. Despite negative mammography, a breast MRI confirmed a mammary nodule, which was removed, and a ductal infiltrating breast carcinoma diagnosis was made. Her neurological condition partially improved after steroid therapy. Our final diagnosis was probable IPM, according to PNS criteria. This rare condition affects most frequently middle-aged women and is often associated with breast and lung cancer, even if two-thirds of patients’ cancer diagnosis is subsequent to the onset of neurological deficits. Clinical presentation is often subtle, and CSF analysis, neuroimaging, and onconeural autoantibodies could be negative or non-specific. However, if the suspect of paraneoplastic disease is strong, cancer should be searched thoroughly since early diagnosis and treatment are associated with a better outcome.

Invasion of chronic lymphocytic leukemia (cll/sll) bloodstream tumor cells by borrelia spirochetes

A sixty-six-year-old woman with a strong family history of breast cancer noted gradual onset of axillary lymph node enlargement in 2019. Axillary lymph node biopsies disclosed Lymph node involvement by Chronic Lymphocytic Leukemia (CLL/SLL). Immunophenotype analysis of nodal tissue and of bloodstream leukemic cells in immunohistochemistry and flow cytometry and next generation molecular diagnostics confirmed CLL/SLL. Replicate absolute peripheral blood lymphocyte counts in excess of 5.0x10e3/microliter confirmed the numerical threshold for diagnosis of Chronic Lymphocytic Leukemia in the bloodstream. FISH studies disclosed an immunoglobulin “mutation negative” CLL/SLL genotype without a light chain restriction pattern. No translocations or germline mutations were present. Borrelia spirochetes in the bloodstream were detected with simultaneous high spirochetemia of both borrelia miyamotoi and borrelia burgdorferi. FISH hybridization of leukemic lymphocytes disclosed extensive borrelia invasion of the cytoplasm and of the nucleus compartments of CLL/SLL tumor cells. Retrospective studies of the patient’s archival stored blood smears obtained three years prior in 2016 at age 63 disclosed no evidence of CLL/SLL but confirmed asymptomatic bloodstream borrelia miyamotoi and borrelia burgdorferi borrelia infection. Lyme serology had been reported as negative in 2016. Additionally, retrospective FISH DNA hybridizations focused on preleukemic bloodstream Lymphocytes disclosed rare borrelia spirochetal adherence to benign blood lymphocytes in the year 2016 in the preleukemic blood smears. This case report is the very first to describe precursor chronic asymptomatic Lyme borreliosis and Miyamotoi borrelia bloodstream infections three years prior to the diagnosis of Rai Stage 1 Chronic Lymphocytic leukemia.

Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine.

One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3months. This required caution and additional examination of the axillary lymph nodes in this period.

Disease Control of Inoperable HER2-Positive Breast Cancer by Targeted Molecular Drugs and Radiotherapy: A Case Report

Background: The number of elderly patients with breast cancer has increased in recent years, many of whom reside alone. This makes choosing their treatment difficult because of domestic considerations and declining physical and cognitive functions. Chemotherapy is often omitted owing to age, and treatment can subsequently be inadequate. Case presentation: Our patient was an 82-year-old woman presenting with the chief complaint of an enlarged left breast mass. The mass had undergone self-destruction with hemorrhage and enlarged left axillary and supraclavicular lymph nodes. She lived alone; therefore, initial chemotherapy of trastuzumab (HER)+pertuzumab (PER)+weekly paclitaxel (wPTX) two-step dose reduction was performed in the hospital. A subcutaneous mass appeared, which disappeared after irradiation. Subsequently, tri-weekly HER+PER administration was continued. Conclusion: A multidisciplinary approach to therapy may offer elderly patients living alone with inoperable breast cancer patients the ability to continue treatment and control their disease following careful consideration of their comorbidities and decline in physical and cognitive functions. Such multidisciplinary treatment options minimize the occurrence of side effects, allowing for long-term continuation of therapy, helping to maintain quality of life and potentially prolonging overall survival.

Clinical and Genetic Characteristics of BCG Disease in Chinese Children: a Retrospective Study.

Summarize the characteristics of a large cohort of BCG disease and compare differences in clinical characteristics and outcomes among different genotypes and between primary immunodeficiency disease (PID) and patients without identified genetic etiology. We collected information on patients with BCG disease in our center from January 2015 to December 2020 and divided them into four groups: chronic granulomatous disease (CGD), Mendelian susceptibility to mycobacterial disease (MSMD), severe combined immunodeficiency disease (SCID), and gene negative group. A total of 134 patients were reviewed, and most of them had PID. A total of 111 (82.8%) patients had 18 different types of pathogenic gene mutations, most of whom (91.0%) were classified with CGD, MSMD, and SCID. CYBB was the most common gene mutation (52/111). BCG disease behaves differently in individuals with different PIDs. Significant differences in sex (P < 0.001), age at diagnosis (P = 0.013), frequency of recurrent fever (P = 0.007), and vaccination-homolateral axillary lymph node enlargement (P = 0.039) and infection severity (P = 0.006) were noted among the four groups. The CGD group had the highest rate of males and the oldest age at diagnosis. The MSMD group had the highest probability of disseminated infection (48.3%). The course of anti-tuberculosis treatment and the survival time between patients with PID and without identified genetic etiology were similar. Greater than 80% of BCG patients have PID; accordingly, gene sequencing should be performed in patients with BCG disease for early diagnosis. BCG disease behaves differently in patients with different types of PID. Patients without identified genetic etiology had similar outcomes to PID patients, which hints that they may have pathogenic gene mutations that need to be discovered.

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome with Toxic Epidermal Necrolysis: Overlap in an HIV Seropositive Male with Diffuse Large “B” Cell Lymphoma – A Rare Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction with varied presentations. We report a rare case of DRESS syndrome with toxic epidermal necrolysis (TEN) overlap associated with non-Hodgkin lymphoma (NHL). A 52-year-old male with retroviral disease presented with fever and diffuse skin peeling with mucosal erosions. The patient was on antitubercular therapy (ATT) for 1 month for suspected tubercular cervical lymphadenitis. He had facial edema, extensive skin tenderness, and denudation with a positive Nikolsky’s sign, icterus, hepatosplenomegaly and multiple enlarged immobile nontender cervical, and axillary and inguinal lymph nodes. Investigations showed leukocytosis with hepatic and renal dysfunction. Skin histopathology was consistent with TEN. Based on Registry of Severe Cutaneous Adverse Reaction criteria, a diagnosis of ATT-induced DRESS with TEN overlap was made. Cervical lymph node biopsy and immunohistochemistry confirmed diffuse large B-cell NHL. ATT was withheld and the patient was treated with systemic steroids and assessed for initiation of chemotherapy. The profound immunological dysregulation in individuals with retroviral disease leads to varied clinical presentations, increasing the chances of diagnostic errors, and culminating in challenging scenarios. Therefore, seemingly innocuous symptoms and signs warrant thorough evaluation. Sound clinical acumen and prompt investigations for unusual causes such as malignancies can improve outcomes by aiding accurate diagnosis as well as avert untoward complications such as DRESS syndrome/TE.

Non-Hodgkin’s Lymphoma Presenting Section as a Soft Tissue Mass on Right Thigh

Non-Hodgkin’s Lymphomas (NHL) are a heterogeneous group of lymphoproliferative malignancies with a greater preference for disseminating to extranodal locations. Prevalence of extranodal involvement in NHL has increased in the past decade, and the sites involved are the stomach, spleen, waldeyer’s ring, Central Nervous System (CNS), lungs and skin. This is a rare case of NHL in a 48-year-old female who presented with solitary exophytic mass with ulceration over the right thigh and erythematous plaque over postaxillary region and enlarged right inguinal and left axillary lymph nodes. Magnetic Resonance Imaging (MRI) of the right thigh showed lobulated mass involving skin and subcutaneous soft tissues without any intramuscular extension suggestive of neoplastic mass. Fine needle aspiration cytology of the inguinal node and biopsy of the right thigh lesion showed features suggestive of NHL. She was treated with three cycles of Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone (CHOP) regimen, but the patient succumbed to death after six months of chemotherapy