Left Cervical Node Research Articles

A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma

ABSTRACT Background This is a case report of synchronous, noncollision head and neck malignancies, consisting of a large polymorphous low-grade adenocarcinoma (PLGA) and an unknown primary squamous cell carcinoma (SCC) that was diagnosed on final pathology. Materials and methods Positron emission tomography– computed tomography (CT) scan with and without contrast was obtained, which showed a large destructive soft tissue mass emanating from the right maxilla into the right maxillary sinus with invasion into the surrounding tissue and bone, compatible with an underlying primary maxillary malignancy. Increased D-18 fluorodeoxyglucose activity was also seen in the neck corresponding to numerous bilateral cervical lymph nodes. Magnetic resonance imaging showed the extent of the soft tissue mass, which expanded to the inferior aspect of the right orbital floor, with no evidence of gross invasion into the orbit. Results The patient underwent a subtotal maxillectomy, bilateral modified radial neck dissection, and reconstruction. Pathology revealed metastatic PLGA present in the right cervical lymph nodes. Left cervical lymph nodes, however, revealed metastatic SSC. The patient was taken back to the operating room and a panendoscopy was performed. Physical examination was benign and multiple biopsies were negative for SSC. The patient underwent radiation therapy for PLGA and unknown primary SSC antigen. Conclusion Synchronous tumors of the head and neck are seldom reported and they present unique treatment challenges. This case report discusses the diagnosis, management, and unique nature of two malignant synchronous noncollision tumors in the head and neck. How to cite this article Fisher AD, McClure SA, Franco J. A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma. Int J Head Neck Surg 2015;6(4):181-186.

Passive and specific targeting of lymph nodes: the influence of the administration route

AbstractPatients diagnosed with an advanced-stage cancer present a dismal prognosis due to the presence of metastases. From the primary tumor, the cancer cells are disseminated via lymphatic circulation; metastases develop initially in lymph nodes. Therefore, the targeting of lymph nodes needs to be improved in the design of future chemotherapy, and one way to ensure this targeting is by using the subcutaneous (SC) route. Using lipid nanocapsules (LNCs) (40 nm and fluorescently-labeled with DiD) as nanocarriers, a correlation between the SC injection site (behind the neck, the right and left flanks, and above the tail) for LNC administration and specific lymph node accumulation (left and right cervical, axillary and inguinal lymph nodes) was achieved for Sprague-Dawley rats. The pharmacokinetic and biodistribution profiles confirmed the absence of LNCs in systemic circulation after SC administration due to the optimal size of the LNCs. With appropriate SC administration, LNCs can accumulate in specific lymph nodes, whereas IV administration led to a weak accumulation of LNCs in all lymph nodes. Specific accumulation followed the lymph flow: bottom-up from the lower to upper limbs and top down from the head, with two lymph circulation partitions: right upper limb and the rest. Administration above the tail presented high inguinal and axillary lymph node accumulation whereas weak accumulation was observed after administration behind the neck. LNCs administered in the left flank only accumulated in the left inguinal and axillary lymph nodes, whereas left and right inguinal and axillary lymph nodes presented accumulation after administration in the right flank. Cervical lymph nodes, in the opposite direction of lymph flow, were never targeted after SC administration, whatever the injection site.

Prostate cancer metastatic to the cervical lymph nodes.

Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age.

Are all left supraclavicular lymphadenopathies Virchow′s? A retrospective study of 320 left cervical lymphadenopathy

Background: Cervical Lymphadenopathy is one of the commonest and sometimes only clinical finding for a benign and malignant lesion. Fine needle aspiration cytology (FNAC) is a simple, safe, rapid and inexpensive method for establishing the diagnosis of lesions. Metastasis is more common in cervical lymph node and enlarged cervical nodes in an elderly patient must be considered as metastatic until proved otherwise. Methods: Retrospectively, 320 cases of left cervical lymph node FNAC were collected from five years record (May 2010 - June 2014) at Sri Devaraj Urs Medical College, Tamaka, Kolar. Review of all cytological reports were done according to standard guidelines and the morphological features of all non-neoplastic and neoplastic lesions were analysed. Results: Out of 320 cases 33% showed reactive lymphadenitis, 29% showed metastatic deposits, 14% showed features of granulomatous and necrotizing lymphadenitis, 9% were tuberculous lymphadenitis. In the present study, reactive lymphadenitis was the most common cause of enlarged lymph nodes followed by metastatic deposits. Squamous cell carcinoma is the most common metastatic lesions of lymphnode and comprise of 65% of the cases. Out of 62 cases of SCC 74% were keratinized, 16% were non keratinized, 29% cases showed granulomas. Non keratinization, presence of granuloma, plasma cells and eosinophils favours metastasis from nasopharyngeal carcinoma. Keratinization favours squamous cell carcinoma and absence of eosinophils and plasma cells in the background favors SCC metastasis from other sites. Conclusion: The present study highlight the usefulness of FNAC in left cervical lymphadenopathy where metastasis is common. Thus the knowledge about the cytological features and patterns will help the clinician to detect the respective cases early for investigations and treatment.

Mediastinal and peripheral lymphadenopathy

A 32-year-old man, with no history of cigarette smoking, had four weeks history of non productive cough, chest pain and myalgias. Physical examination revealed a painless bilateral cervical lymphadenopathy, the respiratory examination was normal. Chest radiography showed an enlarged upper and middle mediastinum (A). Computed tomography (CT) of the thorax showed a large and non homogeneous mass in the anterior and middle mediastinum and a small pericardial effusion, with displacement of vascular structures (B). Laboratory analysis revealed an elevated lactate dehydrogenase level of 690 IU per liter. The exicional biopsy of the left cervical lymph node revealed a caseating and necrotizing granulomatous lesions and confirmed a diagnosis of lymph node tuberculosis. The biopsy of the right cervical lymph node established a B-cell non-Hodgkin lymphoma, and so a rare association with tuberculosis. The patient received anti-tuberculosis therapy. The regimen was based on two months of ethambutol, rifampicin, pyrazinamide and isoniazid, followed by four months of rifampicin and isoniazid. He received also chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisolone. The patient presented, two months later with clinical and radiographic improvement.

A Rare Case of Chronic Lymphocytic Leukemia (CLL), Transforming to Two Different Types of Aggressive Lymphoma during the Course of the Disease.

A rare case of chronic lymphocytic leukemia (CLL), Transforming to two different types of aggressive lymphoma during the course of the disease.BACKGROUNDPatients with chronic lymphocytic leukemia may have disease transformation to non-Hodgkin’s lymphoma (DLBL)or prolymphocytic leukemia (PLL)To date there have been no cases in the english literatures reporting a CLL patient presenting with transformation to both of these different types of more aggressive diseases during the course of their disease. We describe a rare case of CLL who developed transformation to PLL and DLBL, also known as Richter’s transformation(RT) respectively during the course of disease.CASEA 53 year old woman with no significant prior medical history who initially presented with leukocytosis of 14500 and cervical lymphadenopathy on physical examination. Excisional biopsy and microscopic examination confirmed the diagnosis of chronic lymphocytic leukemia with microscopic features of monotonous population of small mature-appearing lymphocytes. Immunohistochemical studies are positive for CD5 and CD23, CD38 and ZAP 70. Concurrent review of peripheral blood smear was showed leukocytosis with relative lymphocytosis and smudge cells. A computed tomography scan of the neck, chest, abdomen and pelvis performed and was remarkable for cervical lymphadenopathy and she was subsequently staged as RAI I of CLL/SLL.The patient was asymptomatic and was therefore observed expectantly for 10 months. Then due to progression of lymphocytosis and extensive cervical lymphadenopathy, she began treatment with chemotherapy consisting of Rituxan, Cytoxan and Fludarabine. After 18 months of being in remission after treatment she again developed cervical lymphadenopathy and night sweats.Exisional biopsy of left cervical lymph node performd and flow cytometric analysis of the lymph node was positive for CD-20, PAX-5, and BCL-2 . Also 97% of these B cells expressed CD38, which is associated with a more aggressive course in CLL, and was supportive for prolymphocytic transformation of CLL. She has been initiated on chemotherapy including bendamustine and Rituxan for a total of four cycles.Patient had a good response to treatment for nine months until she palpated a lymph node in left submandibular area and subsequent excisional lymh node biopsy showed recurrence of the disease with prolymphocytic transformation. The patient began to receive chemotherapy with (R-CHOP) regimen after confirmation of recurrence. A month after completion of chemotherapy, patient had developed increasing lymphadenopathy in neck.Microscopic exam of the biopsy showed foci of CLL/SLL cells and Some binucleated large cells with Immunohistochemical stains, positive for CD20 and weak positivity for CD5 and negativity for CD23, CD10 and BCL6. Immunohistochemical stain for KI-67 shows 70-80% proliferation rate in large cells and less than 10% proliferation rate in background CLL cells which indicates Richter’s transformation of CLL/SLL to diffuse large B-cell lymphoma with an activated B-cell phenotype, which is the most common histologic variant of Richter transformation.CONCLUSIONChronic lymphocytic leukemia(CLL) is an indolent B-cell non-Hodgkin’s lymphoma and is the mostcommon leukemia in the western world with a heterogenous and mostly prolonged disease course, that may transform into higher grade lymphoma. Transformation of CLL to a more aggressive lymphoma occurs in about 5-10% of patients, and is generally accociated with acceleration of the disease and poor clinical prognosis. The transformation involves an increased number of Prolymphocytic cells, termed PLL transformation or the development of DLBCL which also reffered to as Richter’s transformation. DisclosuresNo relevant conflicts of interest to declare.

Inflammatory myofibroblastic tumors of the nasal cavity and paranasal sinus: a clinicopathologic study of 25 cases and review of the literature

Inflammatory myofibroblastic tumor (IMT) is rare in nasal cavity and paranasal sinus. The aim of this study was to describe the clinicopathological features of sinonasal IMT and analyze the relationship between the clinicopathological features and the prognosis. A retrospective study of 25 IMT patients between 2001 and 2012 was performed. Data on clinical features, treatment, and follow-up were recorded. The histological characters were observed. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan-Meier method. Clinically, the most common symptoms were nasal obstruction, facial pain, and toothache. Twenty patients received follow-ups 6-120months after initial diagnosis. Fifteen (75%) developed recurrence 1 or more times. One patient had left cervical lymph node metastasis (5%). Five patients died of the tumor (25%). Histologically, the IMTs composed of bland spindle cells admixed with a prominent infiltrate of plasma cells and lymphocytes and showed obvious atypia in recurrent cases. Histology with necrosis, mitosis (≥1/10 HPF), ganglion-like cells, histological pattern I or II and relapse (≥4 times) was significantly associated with poor OS and EFS. IMT of the nasal cavity and paranasal sinuses exhibits relatively bland histologic appearances, but can shows strongly aggressive behavior and relatively poor outcomes. Multiple relapse, necrosis, frequent mitosis, the presence of ganglion-like cells, and histological pattern might be associated with poor clinical outcomes.

Biphasic synovial sarcoma of the cervical esophagus confirmed by the presence of SYT-SSX1 fusion transcripts

Synovial sarcoma of the digestive tract, including that of the esophagus, is extremely rare. To our knowledge, only 9 cases of primary synovial sarcoma of the esophagus have been reported worldwide. Here, we describe the case of a 70-year-old man who presented with dysphagia and hoarseness, which he had been experiencing for 4 months. A pigmented polypoid mass was detected at the cervical esophagus and spindle cell sarcoma was suspected on the basis of biopsy findings. Two operations were performed to completely excise both the tumor and regional lymph nodes. The tumor was diagnosed as a biphasic synovial sarcoma on the basis of the detection of SYT-SSX1 fusion transcripts by reverse transcription-polymerase chain reaction and fluorescence in situ hybridization. Twenty-two months following surgery, the patient developed local recurrence and received radiotherapy with 60 Gy in 30 fractions. Post-treatment follow-up uncovered the presence of left cervical lymph node metastases that were then removed. Approximately 1 month after resection, multiple metastases developed in the lungs. At his request, the patient did not receive any chemotherapy and died at 42 months after the first operation.

Combined small cell carcinoma of the sinonasal tract associated with syndrome of inappropriate secretion of antidiuretic hormone: A case report.

Combined small cell carcinoma (SmCC) and squamous cell carcinoma (SqCC) is a rare malignant neoplasm in the head and neck. This study presents the first reported case of combined SmCC and SqCC originating from the sinonasal tract accompanied by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). An 80-year-old female presented with a four-week history of right nasal discharge, nasal obstruction and left neck swelling. Imaging studies revealed a tumorous lesion in the maxillary sinus encroaching upon the right nasal cavity and left cervical lymph node (LN) swelling. An incisional biopsy carried out from the right maxillary sinus and LNs resulted in a diagnosis of combined SmCC with SqCC, staged as T4aN2cM0. Clinical examination revealed a sustained increase of antidiuretic hormone, hyponatremia with urinary sodium increase, and serum hypo-osmosis, resulting in SIADH. Water restriction to <1,000 ml/day was effective in improving sodium and osmotic imbalance. Curative treatment for the tumor was not prescribed due to the poor condition of the patient. Palliative treatment was administered and the patient succumbed to cachexia five months after histological diagnosis. The presence of SIADH may have marked implications for the treatment and prognosis of this disease.

Pediatric Presentation of Splenic Marginal Zone Lymphoma on FDG PET/CT Scan

Splenic marginal zone lymphoma (SMZL) comprises about 1% of B-cell lymphomas and typically occurs after the age of 50 years. Pediatric SMZL is very rare, and no FDG PET/CT imaging of the disease has been reported. In the current study, a 4-year-old boy with biopsy-proven SMZL had FDG PET/CT for staging, which showed increased metabolic activity in the spleen and left cervical lymph nodes. A second FDG PET/CT for evaluation of treatment response showed complete resolution of abnormal FDG uptake in the nodes and spleen with decrease in size of the nodes.

Metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves′ disease

Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease. The subject of this presentation is a 50-year-old lady who was diagnosed with Graves' disease at the age of 29, for which she had a subtotal thyroidectomy following failure of medical and radioactive iodine treatment. Three years later, the patient was referred to our nuclear medicine department with a clinical diagnosis of suspected metastatic lymph nodes presumably from a thyroid malignancy.She had an 123I diagnostic whole body scan that showed 123I avid areas in the thyroid bed as well as left cervical lymph nodes, which later turned out to be metastatic papillary carcinoma of the thyroid on histology. She was treated with therapeutic doses of 131I. Follow-up radioactive iodine scans and serum thyroglobulin assays showed no evidence of malignant thyroid tissue. The occurrence of papillary carcinoma of the thyroid after a subtotal thyroidectomy for Graves' disease is hereby reported. The need for vigilance and regular follow-up in patients who receive all forms of treatment for benign thyroid diseases is emphasized.

Classical hodgkin lymphoma (nodular sclerosis type) associated with langerhans cell histiocytosis: a case report on fine-needle aspiration cytologic features

Langerhans cell histiocytosis (LCH) can be associated with a variety of malignant neoplasms, the most common being malignant lymphoma, especially Hodgkin lymphoma (HL). In the present report we describe the fine needle aspiration (FNA) cytologic features of a case with concurrent LCH and HL in a lymph node. A 20-year-old man presented with an enlarged left upper cervical lymph node. FNA smears from the swelling revealed numerous CD1a+ and S-100+ Langerhans histiocytes (LCs) along with many eosinophils, neutrophils, and lymphocytes; there were also large atypical cells with enlarged nuclei having prominent nucleoli. The cytodiagnosis was LCH and the possibility of association with or trans-differentiation into a lymphoma was suggested. The histopathological diagnosis of the excised lymph node was classical Hodgkin lymphoma-nodular sclerosis type (CHL-NS) with LCH. The lacunar type Reed-Sternberg (RS) cells were positive for CD30 and CD15 while the LCs were positive for CD1a and S-100 protein. PET/CT imaging of vertex to mid-thigh demonstrated hypermetabolic lymph nodes in the neck, abdomen, thorax and pelvis as well as pulmonary nodules and a splenic mass. The patient received courses of chemotherapy and two years later, the enhanced CT of neck, chest, abdomen and pelvis revealed regressive course of the disease.

Kawasaki Disease with Retropharyngeal Edema following a Blackfly Bite.

We describe a patient with Kawasaki disease (KD) and retropharyngeal edema following a blackfly bite. An 8-year-old boy was referred to our hospital because of a 3-day-history of fever and left neck swelling and redness after a blackfly bite. Computed tomography of the neck revealed left cervical lymph nodes swelling with edema, increased density of the adjacent subcutaneous tissue layer, and low density of the retropharyngeum. The patient was initially presumed to have cervical cellulitis, lymphadenitis, and retropharyngeal abscess. He was administered antibiotics intravenously, which did not improve his condition. The patient subsequently exhibited other signs of KD and was diagnosed with KD and retropharyngeal edema. Intravenous immunoglobulin therapy and oral flurbiprofen completely resolved the symptoms and signs. A blackfly bite sometimes incites a systemic reaction in humans due to a hypersensitive reaction to salivary secretions, which may have contributed to the development of KD in our patient.

Unsuspected Active Sarcoidosis Diagnosed by 18F-FDG PET/CT During the Search for a Primary Tumour in a Patient with Bone Lesions.

Sarcoidosis is a systemic chronic inflammatory disease of unknown aetiology, characterised by granulomatous lesions with heterogeneous clinical manifestations affecting multiple organs and tissues. Although the respiratory system is most commonly affected, the disease may also present with bone lesions. We report the case of a 31-year-old woman who presented with low back pain and no history of cancer and who was found to have suspicious lesions involving the entire spine on magnetic resonance imaging (MRI). The patient underwent 18F-fluorodeoxyglucose (FDG) PET/CT to search for a primary tumour and for staging purposes. 18F-FDG PET/CT revealed a pattern of hypermetabolic activity in widespread skeletal lesions and in a single left cervical lymph node. The primary tumour was not found, thus suggesting a haematologic disorder. Subsequent biopsies of a cervical lymph node and of bone tissue from L4 revealed active sarcoidosis with no evidence of cancer. This underlines the importance of considering all alternatives when hypermetabolic lesions are found on 18F-FDG PET/CT. Furthermore, 18F-FDG PET can be very useful to indicate accessible sites for guiding fine-needle aspiration cytology (FNAC).

Tumours of the Scalp: A Review of Ten Cases

Background: The scalp is a common site for the development of tumours. Most of these tumours are benign; among the malignant ones, squamous cell carcinoma (SCC)) and basal cell carcinoma (BCC) predominate. In Ghana patients with scalp tumours do not report to hospital unless they are symptomatic. Data on the condition is therefore scanty. Patients and Methods: The objective of the study was to document the hospital prevalence and the management outcome of patients with scalp tumours. Patients with tumours of the scalp reporting at the Reconstructive Plastic Surgery and Burns Unit (RPSBU) at Komfo Anokye Teaching Hospital (KATH) who were managed by the author between June 2003 and June 2009 were entered into the study. The patients were examined clinically and the diagnosis confirmed by biopsy. The scalp tumours were excised and the defect closed directly, skin grafted, or repaired with a flap as appropriate. Results: Ten patients with eleven scalp tumours were managed during the study period from June 2003 to June 2009, made up of four males and six females. Their ages ranged from 16 to 70 years, with a mean age of 41.7 years. Two benign scalp tumours, a sebaceous cyst and a sebeceoma were located in the frontal region; five cases of SCC and one case of basosquamous cell carcinoma (BSC) in the parietal region, two cases of SCC in the temporal region, and one case of SCC in the occipital region of the scalp. Eight of the tumours developed de novo from the scalp; one developed from a chronic burn scar (Marjolin’s ulcer); two tumours developed from the scalp of a patient with xeroderma pigmentosum. Two patients had excision and direct closure of the defect; six had excision and skin grafting; two had excision and flap repair. One patient had block dissection of the left cervical lymph nodes, and two patients had adjuvant radiotherapy. Conclusions: Most tumours of the scalp presenting at the RPSBU at KATH are SCC which developed de novo. Chronic burn scars and xeroderma pigmentosum were some of the aetiological factors identified. Early lesions can be cured by excision and skin grafting.

A case of anaplastic lymphoma kinase‐positive large B‐cell lymphoma: Aspiration cytology findings

Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of non-Hodgkin B-cell lymphoma that exhibits a more aggressive clinical course and poorer prognosis than the typical diffuse large B-cell lymphoma. In this study, we report the case of a 67-year-old man with left cervical lymph node swelling. Aspiration cytology revealed many clusters of cohesive, large, and solitary cells. The tumor cells had abundant cytoplasm and large round-to-oval nuclei with prominent nucleoli. The Giemsa staining specimens exhibited amorphous global bodies adjacent to some clusters. Histologically, large tumor cells occupied the lymph nodes in a sinusoidal pattern, and immunohistochemically, these cells were cytokeratin-, CD19(-), CD20(-), CD79a(-), CD3(-), CD30(-), CD138(+), IgG(-), IgA(+), and ALK(+). Chromogenic in situ hybridization revealed restricted immunoglobulin light-chain expression. Fluorescent in situ hybridization demonstrated translocation of the ALK gene. The tumor cells were negative for Epstein-Barr virus and human herpesvirus 8. It is important to differentiate ALK+LBCL from metastatic carcinoma and other lymphoma subtypes with similar histological features to ensure a proper treatment strategy and prediction of prognosis.

Mycobacterial inflammatory pseudotumour of the neck – a potential diagnostic pitfall

Inflammatory pseudotumour has been applied to a group of diverse entities including inflammatory myofibroblastic tumour, pseudosarcomatous reparative lesions such as myofibroblastic proliferation of the lower genitourinary tract, infectious lesions and inflammatory-follicular dendritic cell neoplasm. Within the group of inflammatory lesions, mycobacterium is known to result in a histiocytic proliferation resembling a soft tissue neoplasm. In this report, we detail an instance of mycobacterial inflammatory pseu-dotumour affecting a 40-year-old Chinese man with a known history of retroviral disease and mycobacterium avium-intracellulare (MAI) infection. He presented with diffuse lymphadenopathy for a year while on antibiotic therapy for MAI. On CT scan, multiple enlarged lymph nodes were noted in the neck, thorax and abdomen. As there was a clinical suspicion of malignancy, namely lym-phoma, excision of the left cervical lymph node was performed. On histology, there was diffuse and predominant proliferation of spindle cells with a sprinkling of lymphocytes and plasma cells, simulating a mesenchymal tumour. Ziehl-Neelsen stain revealed an abundance of acid fast bacilli and immunohistochemistry stain for CD163 confirmed the spindle cells to be histiocytic in origin. The diagnostic problems associated with a mycobacterial inflam-matory pseudotumour are presented.

下顎骨内に広範に進展した原発不明悪性黒色腫の1例

To our knowledge, a case of primary oral malignant melanoma (MM) invading mainly the jaw has yet to be reported. We report a case of MM that spread widely in the mandibular medullary cavity with limited involvement of the mucosa. A 40-year-old woman visited our hospital because of mobility of the lower right second molar. Initial examination showed that the second molar floated, and the gingiva was pale purple-blue. An X-ray film showed a diffuse radiolucent area from the premolar to the ramus of the right mandible. The diagnosis of a biopsy specimen was MM, and no distant metastasis was detected on whole body examination. A wide tumor resection with radical neck dissection and immediate reconstruction were performed. Histopathological examination of the specimen revealed MM invading mainly the mandibular bone marrow; however, the primary site remained unknown. DAV-Feron therapy was given postoperatively. Three months later, left cervical lymph node metastasis was detected, and neck dissection was performed. Three years after the first visit, a metastatic lesion in the pleural space was excised by thoracosopic surgery. Ten courses of DAV-Feron therapy were completed, and the patient is now under observation.

Positron emission tomography for staging and response assessment of mycosis fungoides in a child

Sir,We report our experience with positron emission tomography and computerized tomography scan (PET-CT) in mycosis fungoides (MF). A 12-year-old boy presented with pruritic erythematous rash over left shin for 2 years. He was initially treated outside our center with topical steroids and antibiotics with minimal improvement. On examination, he had multiple hypopigmented macules on the back and buttocks and a well-defined erythematous to violaceous 6 × 6 cm plaque over medial aspect of left leg [Figure 1a]. He had few soft cervical lymph nodes (LN) measuring 1 cm. Skin biopsy from a macule on the back was non-contributory. Biopsy from left leg plaque showed atypical lymphocytic infiltratein lower and upper dermis, with epidermotropism [Figure 1b]; lymphocytes were CD3-positive and negative for CD20 and CD30. Thus, the findingssuggested a diagnosis of MF. CT scan of chest and abdomen revealed only horseshoe kidney. Left cervical LN biopsy showed dermatopathic lymphadenitis. Peripheral blood smear and bone marrow biopsy were normal. A whole body

Epstein-Barr virus-associated lymphoproliferative disorder developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin’s lymphoma

Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations that develop as a consequence of immunosuppression in a recipient of a solid organ, bone marrow or stem cell allograft. The development of PTLDs is usually associated with Epstein-Barr virus (EBV) and the disorder is also termed EBV-associated lymphoproliferative disorder (LPD). The development of PTLD is a rare complication in autologous bone marrow/peripheral blood stem cell transplantation. In the present study, we report a case of EBV-associated LPD which developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin's lymphoma. A 51-year-old male presented with swelling of the left cervical lymph nodes. A biopsy revealed nodular sclerosis classical Hodgkin's lymphoma. Following four courses of ABVd (adriamycin, bleomycin, vinblastine, dacarbazine) therapy, the Hodgkin's lymphoma relapsed. CHASE (cyclophosphamide, etoposide, cytarabine, dexamethasone) therapy and autologous peripheral blood stem cell transplantation were performed. In the 128 days following the transplantation, lymph node swelling was noted and a biopsy specimen demonstrated EBV-associated LPD. The serum copy number of EBV-DNA was 2.7×10(3) copies/ml. The occurrence of EBV-associated LPD may be on the rise due to the increased number of patients undergoing immunosuppression therapy. The measurement of the serum EBV-DNA copy number and the detection of EBV-infected atypical lymphocytes using in situ hybridization are significant in establishing an early accurate diagnosis and initiating the correct treatment for EBV-associated LPD in patients with immunosuppression.