Ipsilateral Cervical Lymphadenopathy Research Articles

Primary Peritonsillar Tuberculosis in a Rheumatoid Arthritis Patient Treated With Methotrexate.

A 48-year-old man diagnosed with rheumatoid arthritis was treated with methotrexate for 10 years. He presented left tonsil ulceration and ipsilateral cervical lymphadenopathy. A tonsillar biopsy revealed tuberculosis. The patient received antituberculous therapy for 8 months with a positive response. However, after resumption of methotrexate due to worsening rheumatoid arthritis, symptoms recurred. The patient initiated antituberculous therapy once more for 6 months, and methotrexate was stopped. At regular follow-up, the patient showed a positive clinical response with resolution of tonsillar ulceration and lymphadenopathy after 14 months of antituberculosis treatment.

Immunoprofiles and Oncologic Outcomes of 15 Patients with Androgen Receptor-Positive Salivary Duct Carcinoma.

Salivary duct carcinomas (SDC) are a rare and aggressive subtype of salivary gland neoplasm. They can present with distinct immunoprofiles, such as androgen receptor (AR) and HER-2/Neu-positivity. To date, no consensus exists on how to best manage this entity. All patients diagnosed with nonmetastatic AR+ SDC of the parotid from 2013 to 2019 treated with curative intent were included. Immunologic tumor profiling was conducted using 24 distinct markers. Kaplan-Meier analyses were used to estimate locoregional recurrence (LRR), distant control, and overall survival (OS). Fifteen patients were included. Nine (60%) patients presented with T4 disease and eight (53%) had positive ipsilateral cervical lymphadenopathy. Ten (67%) patients underwent trimodality therapy, including surgery followed by adjuvant radiation and concurrent systemic therapy. The median follow-up was 5.5 years (interquartile range, 4.8-6.1). The estimated 5-year rates of LRR, distant progression, and OS were 6%, 13%, and 87%, respectively. Despite only including AR+ SDC of the parotid, immunoprofiles, such as expression of HER-2, were highly variable, highlighting the potential to tailor systemic regimens based on individual histologic profiles in the future. Studies with larger patient numbers using tumor-specific molecular profiling and tumor heterogeneity analyses are justified to better understand the biology of these tumors. Molecularly informed treatment approaches, including the potential use of AR- and HER-2/Neu-directed therapies upfront in the definitive setting, may hold future promise to further improve outcomes for these patients.

Lymphoepithelial Carcinoma of the Palatine Tonsil

Abstract Lymphoepithelial carcinoma is an undifferentiated carcinoma with nonneoplastic lymphoplasmacytic infiltrate, mostly located in the nasopharynx, while it is extremely rare in the oropharynx. We present a rare case of lymphoepithelial carcinoma arising from palatine tonsil. A 81-year old male patient complained of dysphagia, hypersalivation and bloody sputum. Clinical examination revealed hypertrophy of the right palatine tonsil and ipsilateral cervical lymphadenopathy. Biopsy and histopathological analysis confirmed the diagnosis of lymphoepithelial carcinoma. Multi-slice computed tomography showed a 33x31x38 mm heterodense mass in the region of the right palatine tonsil, and 37x30 mm and 21x20 mm lymph nodes on the right side of the neck. The patient was reffered to an oncology council, which suggested radiotherapy and concurrent chemotherapy. Although rare in clinical practice, lymphoepithelial carcinoma should be considered in cases of tonsil cancer.

Calcitonin Non-Secreting Mixed Medullary-Papillary Thyroid Carcinoma: Report of a Rare Entity and Therapeutic Implications

Background: Medullary thyroid carcinoma (MTC) is a relatively rare and aggressive form of thyroid malignancy arising from parafollicular cells. The biochemical hallmark of MTC is elevated serum calcitonin (CTN), which aids initial diagnosis and disease surveillance. An atypical form of calcitonin non-secreting MTC has been previously described, with just over 50 cases published in the literature. This case report of a true mixed medullary-papillary thyroid carcinoma with a non-secretory medullary component is exceptionally rare. Clinical Case: A 67-year-old male presented with new-onset hoarseness and was found to have a 4 cm thyroid nodule replacing the right lobe with associated ipsilateral cord paralysis and ipsilateral cervical lymphadenopathy. The patient had no family history of endocrinopathies. A diagnosis of MTC was rendered at core-needle biopsy, based on the characteristic morphological findings and positive immunohistochemistry (IHC) for calcitonin (CTN) and CEA. Cervico-thoracic CT demonstrated tracheal and esophageal involvement by the tumor. The serum CEA was 8.7 pg/ml [0-5]; however, serum CTN was undetectable < 2 pg/ml [2-8.2]. The patient subsequently underwent a total thyroidectomy with bilateral central neck dissection and right lateral neck dissection. Excision of the tumor necessitated the dissection of involved esophageal muscle from mucosa and removal of four tracheal rings with part of the cricoid. The surgical specimen demonstrated a single 3.6 cm tumor in the right thyroid lobe composed of medullary and papillary intermixed neoplastic cells (mixed MTC-PTC) with predominant medullary component and gross extrathyroidal extension. Positive IHC for calcitonin, CEA, and thyroglobulin confirmed the diagnosis. Out of ninety resected lymph nodes in total, five nodes were involved with medullary carcinoma (with extranodal extension), and three had papillary carcinoma micrometastases. Postoperatively, the patient underwent adjuvant external beam radiation to the surgical bed. At four-month follow-up, CEA levels were 1.4 pg/ml [0-5], TSH 0.04 µIU/ml [0.35-4.9] and thyroglobulin (Tg) with Tg Ab levels were undetectable. The patient continues close surveillance. Conclusion: Calcitonin non-secreting MTC management is challenging due to the lack of a reliable biomarker that aids initial diagnosis, surveillance, and prognostic stratification. Whether a rare form of non-secretory MTC represents a more aggressive variant is yet to be determined. The prognosis of patients with mixed MTC-PTC tumors appears to be driven by the medullary component that prioritizes the optimal surgical approach and further management.

Kikuchi-Fujimoto disease in the regional lymph nodes with node metastasis in a patient with tongue cancer: A case report and literature review.

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare self-limiting disorder typically affecting the cervical lymph nodes (LNs), which is often misdiagnosed as other LN-associated diseases. KFD frequently presents with necrotic lesions and recurrences, which are also features of metastatic LNs. Clinicians may thus suspect LN metastasis when they encounter ipsilateral cervical lymphadenopathy in a patient with head and neck cancer. The present study reports the case of a 48-year-old man with tongue cancer and KFD affecting the right edge of his tongue and ipsilateral cervical LNs. LN metastasis was initially suspected, but pathological examination of the dissected LNs revealed one necrotic metastatic lesion and two necrotic KFD lesions. Ipsilateral cervical lymphadenopathy recurred 6 years after the initial surgery, and it was not possible to differentiate clinically between a second primary tumor and recurrent KFD prior to treatment. To the best of our knowledge, this is the first reported case of simultaneous tongue cancer, regional LN metastasis and KFD. This highlights the requirement to consider KFD in the event of LNs with necrotic lesions but no cancerous cells. A combination of clinical and pathological approaches may aid in the diagnosis of KFD, in addition to ruling out LN metastasis in initial and recurrent lymphadenopathies. The present study indicate that a diagnosis of KFD should be considered in patients with head and neck cancer that exhibit necrotic LNs lacking cancerous cells. This is important, as misdiagnosis of KFD as LN metastasis may lead to unnecessary adjuvant therapy.

CT features and analysis for misdiagnosis of parotid tuberculosis

PurposeTo analyze the computed tomography (CT) features and the reasons for misdiagnosis of parotid tuberculosis (TB). MethodsCT features of 13 cases of parotid TB identified more than a 10-year period (2005–2015) were retrospectively analyzed. The CT features were analyzed for nature, range, and extent of the various pathological patterns. ResultsBecause of the nonspecific CT features, 10 of 13 cases were misdiagnosed as benign and malignant tumors of parotid gland and received surgery. Ten cases of lymph nodal TB, one case of parenchymal TB, and two cases of mixed (concurrence of lymph nodal and parenchymal types) TB were found in the parotid gland. On contrast-enhanced CT scan, two cases showed homogeneous enhancement and eight cases showed ring enhancement (including five cases with thin-walled ring enhancement, two cases with flower-ring enhancement, and one case with thick-walled and eccentric ring enhancement); diffuse enhancement was seen in the one case of parenchymal type; the two cases of mixed type showed diffuse enhancement of parotid gland and ring enhancement of lymph node. Thickened skin around the parotid gland was seen in eight cases, including sinus tract between the lesion and skin in two cases. Ipsilateral cervical lymphadenopathy was found in 10 patients and bilateral was found in 3 patients. ConclusionsNonspecific CT features of parotid TB closely relate with pathological changes. Recognition and understanding the spectrum of CT features of parotid TB is helpful for differential diagnosis, but the definitive diagnosis still depends on laboratory and pathological examination.

Myxofibrosarcoma of the thyroid gland

IntroductionMyxofibrosarcoma of the thyroid is exceptional: a Medline search found a single case report. We report a new case which raised diagnostic and therapeutic problems. ObservationWe report the case of a 74-year-old woman who presented with swelling of the left thyroid lobe and ipsilateral cervical lymphadenopathy. Total thyroidectomy with cervical lymph-node dissection was performed. Histological analysis diagnosed myxofibrosarcoma. Evolution was marked by rapid local recurrence, and chemotherapy based on doxorubicin and ifosfamide was introduced. Discussion/conclusionHead and neck myxofibrosarcoma is rare. MRI is essential and should always precede treatment. Diagnosis is histological. There is elevated risk of local recurrence after resection, accompanied by worsening tumor grade, whence the need for accurate diagnosis, appropriate treatment and regular MRI follow-up.

A boy with Burkitt lymphoma associated with Noonan syndrome due to a mutation in RAF1

This article reports on an association between Burkitt lymphoma and Noonan syndrome (NS) due to a RAF1 gene mutation. The patient was a 7-year-old boy with NS, who was included in the first series reporting the association between Noonan and RAF1, and who later presented with a 2-week history of asymptomatic unilateral tonsillar swelling and ipsilateral cervical lymphadenopathy. Histological and biological examinations of the tonsillar biopsy led to the diagnosis of Burkitt lymphoma. While there is a well-established association between NS and solid cell tumors, this is the first case described in the literature of Burkitt lymphoma in a patient with NS, and adds to the growing list of data supporting neoplasia's association with NS.

Tuberculosis of the Nasolacrimal Duct

Nasolacrimal tuberculosis is rare. The authors present a young Peruvian-born female with subacute onset of right eye epiphora, isolated right inferior turbinate enlargement, and ipsilateral cervical lymphadenopathy. Turbinate and neck mass incisional biopsies demonstrated histopathological findings consistent with tuberculosis. QuantiFERON-TB Gold-In-Tube testing was positive. Complete resolution of symptoms occurred after dacryocystorhinostomy and 9 months of standard 4-drug antituberculosis therapy. Tuberculosis of the nasolacrimal duct is highly unusual but should be considered in patients with tuberculosis risk factors who present with nasolacrimal obstruction from an inferior turbinate mass.

37-Year-Old Woman With Palpitations and Fatigue

37-Year-Old Woman With Palpitations and Fatigue

Tuberculosis of the parotid gland: computed tomographic findings

Tuberculosis (TB) of the parotid gland is rare, even in endemic regions. Approximately 100 cases have been reported in the English literature. The computed tomographic (CT) features, however, have seldom been studied. To determine the diagnostic CT features of tuberculosis of the parotid gland. CT studies of four histologically proven cases of tuberculosis of the parotid gland were retrospectively reviewed. A total of 15 enlarged lymph nodes were found in the superficial lobes of the parotid glands. The nodes were arranged linearly within the gland. Enhancement patterns included homogeneous enhancement (9/15, 60%), homogeneous enhancement with eccentric microcysts (3/15, 20%), and thick-walled rim enhancement with central lucency (3/15, 20%). Thickened adjacent fascial plane and platysma were seen in two patients. Ipsilateral cervical lymphadenopathy was seen in all patients. In patients presenting with unilateral parotid nodules, TB should be considered when linearly arranged enhancing nodules are demonstrated in the superficial lobes of the glands on CT scan.

Salivary gland manifestations of sinus histiocytosis with massive lymphadenopathy: Fine‐needle aspiration cytology findings. A case report

Sinus histiocytosis with massive lymphadenopathy (SHML or Rosai-Dorfman disease) is a nonneoplastic, usually self-limiting disease. Alhough it affects all age groups, it is more commonly seen in young males in their first or second decades. The disease primarily manifests as painless lymphadenopathy of cervical region, but other nodal groups and extranodal sites may also be affected. Seldom SHML may involve the salivary glands. We present the cytologic features and differential diagnoses of one such case.A 45-yr-old woman presented with an enlarged submandibular gland on the left side with ipsilateral cervical lymphadenopathy that had been persisting for 1 mo. The gland and the two enlarged nodes measured 2.5 x 2.5 cm(2) each and were firm in consistency. Clinically, tumor of the salivary glands was suspected. Fine-needle aspiration (FNA) smears showed moderate cellularity, with large histiocytes dispersed in the background of intense lymphoplasmacytic infiltrate. These histiocytes showed lymphophagocytosis. Isolated stromal fragments consisting of fibrocytes were seen separate from salivary acinar clusters on repeat aspirations. The diagnosis of SHML involving left submandibular gland and ipsilateral lymph nodes was returned. When analyzed in the context of clinical findings (laboratory data), the cytologic features of SHML involving salivary gland could be differentiated from those of malignancies and other benign lesions, especially Kuttner's tumor of the submandibular gland, which mimics neoplasm clinically.