Node Lesions Research Articles

Images in Breast Oncology: Extra-Nodal Rosai–Dorfman Disease Mimicking Metastatic Breast Malignancy on PET CT

Rosai–Dorfman disease is a rare disorder wherein there is excessive production and accumulation of histiocytes in the lymph nodes. This excessive deposition may occur in other areas like the skin, central nervous system, kidney, and digestive tract. Also referred to as extra-nodal RDD, these may mimic other diseases in these organs. A postmenopausal lady was referred to us for breast biopsy from another centre. PET CT images taken already were concerning for metastatic breast malignancy. Rosai–Dorfman disease was diagnosed on histopathology based on samples taken from the right breast mass. This case highlighted the rare occurrence of Rosai–Dorfman disease affecting breast and mimicking a metastatic breast primary in the presence of loco-regional nodal disease and numerous lytic lesions in the bone.

T-VEC for stage IIIB-IVM1a melanoma achieves high rates of complete and durable responses and is associated with tumor load: a clinical prediction model.

Talimogene laherparepvec (T-VEC) is a genetically modified herpes simplex type 1 virus and known as an effective oncolytic immunotherapy for injectable cutaneous, subcutaneous and nodal melanoma lesions in stage IIIB-IVM1a patients. This study set out to identify prognostic factors for achieving a complete response that can be used to optimize patient selection for T-VEC monotherapy. Patients with stage IIIB-IVM1a melanoma, treated with T-VEC at the Netherlands Cancer Institute between 2016-12 and 2020-01 with a follow-up time > 6months, were included. Data were collected on baseline characteristics, responses and adverse events (AEs). Uni- and multivariable analyses were conducted, and a prediction model was developed to identify prognostic factors associated with CR. A total of 93 patients were included with a median age of 69years, median follow-up time was 16.6months. As best response, 58 patients (62%) had a CR, and the overall response rate was 79%. The durable response rate (objective response lasting > 6months) was 51%. Grade 1-2 AEs occurred in almost every patient. Tumor size, type of metastases, prior treatment with systemic therapy and stage (8Th AJCC) were independent prognostic factors for achieving CR. The prediction model includes the predictors tumor size, type of metastases and number of lesions. This study shows that intralesional T-VEC monotherapy is able to achieve high complete and durable responses. The prediction model shows that use of T-VEC in patients with less tumor burden is associated with better outcomes, suggesting use earlier in the course of the disease.

Evaluation of 18F-FDG PET/CT images acquired with a reduced scan time duration in lymphoma patients using the digital biograph vision

BackgroundThe superior accuracy and sensitivity of 18F-FDG-PET/CT in comparison to morphological imaging alone leads to an upstaging in up to 30% of lymphoma patients. Novel digital PET/CT scanners might enable to reduce administered tracer activity or scan time duration while maintaining diagnostic performance; this might allow for a higher patient throughput or a reduced radiation exposure, respectively. In particular, the radiation exposure reduction is of interest due to the often young age and high remission rate of lymphoma patients.MethodsTwenty patients with (suspected) lymphoma (6 for initial staging, 12 after systemic treatment, 2 in suspicion of recurrence) sequentially underwent 18F-FDG-PET/CT examinations on a digital PET/CT (Siemens Biograph Vision) with a total scan time duration of 15 min (reference acquisition protocol) and 5 min (reduced acquisition protocol) using continuous-bed-motion. Both data sets were reconstructed using either standalone time of flight (TOF) or in combination with point spread function (PSF), each with 2 and 4 iterations. Lesion detectability by blinded assessment (separately for supra- and infradiaphragmal nodal lesions and for extranodal lesions), lesion image quantification, and image noise were used as metrics to assess diagnostic performance. Additionally, Deauville Score was compared for all patients after systemic treatment.ResultsAll defined regions were correctly classified in the images acquired with reduced emission time, and therefore, no changes in staging were observed. Lesion quantification was acceptable, that is, mean absolute percentage deviation of maximum and peak standardized uptake values were 6.8 and 6.4% (derived from 30 lesions). A threefold reduction of scan time duration led to an increase in image noise from 7.1 to 11.0% (images reconstructed with 4 iterations) and from 4.7 to 7.2% (images reconstructed with 2 iterations). No deviations in Deauville Score were observed.ConclusionThese results suggest that scan time duration or administered tracer activity can be reduced threefold without compromising diagnostic performance. Especially a reduction of administered activity might allow for a lower radiation exposure and better health economics. Larger trials are warranted to confirm our results.

SARS-CoV-2 Causes a Systemically Multiple Organs Damages and Dissemination in Hamsters.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread across the world and impacted global healthcare systems. For clinical patients, COVID-19 not only induces pulmonary lesions but also affects extrapulmonary organs. An ideal animal model that mimics COVID-19 in humans in terms of the induced systematic lesions is urgently needed. Here, we report that Syrian hamster is highly permissive to SARS-CoV-2 and exhibit diffuse alveolar damage and induced extrapulmonary multi-organs damage, including spleen, lymph nodes, different segments of alimentary tract, kidney, adrenal gland, ovary, vesicular gland and prostate damage, at 3–7 days post inoculation (dpi), based on qRT-PCR, in situ hybridization and immunohistochemistry detection. Notably, the adrenal gland is a novel target organ, with abundant viral RNA and antigen expression detected, accompanied by focal to diffuse inflammation. Additionally, viral RNA was also detected in the corpus luteum of the ovary, vesicular gland and prostate. Focal lesions in liver, gallbladder, myocardium, and lymph nodes were still present at 18 dpi, suggesting potential damage after disease. Our findings illustrate systemic histological observations and the viral RNA and antigen distribution in infected hamsters during disease and convalescence to recapitulate those observed in humans with COVID-19, providing helpful data to the pathophysiologic characterization of SARS-CoV-2-induced systemic disease and the development of effective treatment strategies.

Clinicopathological features of adult T-cell leukemia/lymphoma with HTLV-1-infected Hodgkin and Reed-Sternberg-like cells.

Hodgkin and Reed-Sternberg (HRS) cells, a hallmark of classic Hodgkin lymphoma (CHL), are occasionally detected in non-Hodgkin lymphomas, including adult T-cell leukemia/lymphoma (ATLL), a lymphoid neoplasm caused by human T-cell leukemia virus type 1 (HTLV-1). HRS-like cells associated with ATLL have been described to be of B-cell lineage and infected with Epstein-Barr virus (EBV), not HTLV-1. We herein describe clinicopathological findings in 8 cases (4 males and 4 females; median age, 73 years [range, 55-81 years]) of ATLL with HTLV-1-infected HRS-like cells identified by ultrasensitive RNA in situ hybridization for HTLV-1 basic leucine zipper factor (HBZ-ISH), a specific viral transcript of HTLV-1. All patients showed nodal or mediastinal lesions, and 5 of the 8 patients were at an advanced disease stage. HRS-like cells were positive for CD30, CD15, MUM1, CD25, and HBZ-ISH and negative for B-cell markers, including PAX5, pan-T-cell antigens, and EBV in all cases. Five cases were positive for CD4, and 6 cases were positive for fascin. HBZ was identified in both HRS-like cells and surrounding lymphoid cells in 1 case with an aggressive clinical course and only HRS-like cells in 7 cases, most of whom showed a clinical response regardless of the chemotherapeutic regimen. Even though the definitive lineage typing of the HTLV-1-infected HRS cells is one of the limitations of this study in the absence of single-cell microdissection for polymerase chain reaction analysis, the combination of diffuse HBZ-ISH positivity and negativity for PAX5 and EBV deemed these cases distinct from CHL arising in HTLV-1 carriers.

Low value of whole-body dual-modality [18f]fluorodeoxyglucose positron emission tomography/computed tomography in primary staging of stage I\u2013II nasopharyngeal carcinoma: a nest case-control study

ObjectivesThe value of using PET/CT for staging of stage I–II NPC remains unclear. Hence, we aimed to investigate the survival benefit of PET/CT for staging of early-stage NPC before radical therapy.MethodsA total of 1003 patients with pathologically confirmed NPC of stages I–II were consecutively enrolled. Among them, 218 patients underwent both PET/CT and conventional workup ([CWU], head-and-neck MRI, chest radiograph, liver ultrasound, bone scintigraphy) before treatment. The remaining 785 patients only underwent CWU. The standard of truth (SOT) for lymph node metastasis was defined by the change of size according to follow-up MRI. The diagnostic efficacies were compared in 218 patients who underwent both PET/CT and CWU. After covariate adjustment using propensity scoring, a cohort of 872 patients (218 with and 654 without pre-treatment PET/CT) was included. The primary outcome was overall survival based on intention to treat.ResultsRetropharyngeal lymph nodes were metastatic based on follow-up MRI in 79 cases. PET/CT was significantly less sensitive than MRI in detecting retropharyngeal lymph node lesions (72.2% [62.3–82.1] vs. 91.1% [84.8–97.4], p = 0.004). Neck lymph nodes were metastatic in 89 cases and PET/CT was more sensitive than MRI (96.6% [92.8–100.0] vs. 76.4% [67.6–85.2], p < 0.001). In the survival analyses, there was no association between pre-treatment PET/CT use and improved overall survival, progression-free survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival.ConclusionsThis study showed PET/CT is of little value for staging of stage I–II NPC patients at initial imaging.Key Points• PET/CT was more sensitive than MRI in detecting neck lymph node lesions whereas it was significantly less sensitive than MRI in detecting retropharyngeal lymph node lesions.• No association existed between pre-treatment PET/CT use and improved survival in stage I–II NPC patients.

Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients

BackgroundWe prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients.MethodsThis prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow.ResultsIn the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058).ConclusionWB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.

Follicular Dendritic Cell Sarcomas: CT and MRI Findings in 20 Patients.

OBJECTIVE. The objective of this study was to assess the imaging features of follicular dendritic cell sarcoma (FDCS) on CT and MRI. MATERIALS AND METHODS. The clinical data and pretreatment findings of 20 patients with pathologically proven FDCS on CT (n = 15), MRI (n = 7), or both (n = 2) were analyzed retrospectively. Tumor location, number, size, morphology, attenuation or signal intensity, margin, presence of metastases, and contrast enhancement were evaluated. RESULTS. FDCS originated from lymph nodes (n = 6) or a variety of extranodal sites (n = 14). The tumors were typically solitary and well-circumscribed. Extranodal lesions (mostly in the abdomen or mediastinum with mean diameter, 11.8 cm) were larger than nodal lesions (mean diameter, 6.5 cm). Nodal-type cases presented with homogeneous masses on CT and MRI. However, on CT, all extranodal tumors (n = 12) showed heterogeneous attenuation, of which 91.7% (11/12) contained areas of lower attenuation because of internal necrosis and 50.0% (6/12) showed calcifications. On MRI, primary hepatic or splenic tumors (n = 3) also appeared as large heterogeneous masses. Seven patients (35.0%) had advanced-stage disease, and intraabdominal extranodal cases were more likely to have regional lymphadenopathy (n = 4) and distant metastases (n = 5). Hypervascularity was seen in 90.0% (18/20) of patients and progressive enhancement was seen in 11 (78.6%) of 14 tumors with multiphase imaging. CONCLUSION. FDCS is a rare, mostly solitary, well-delineated malignancy. A nodal-type FDCS typically presents as a small homogeneous mass, whereas an extranodal FDCS in the mediastinum or abdomen manifests as a large heterogeneous mass with internal necrosis and calcifications accompanied by regional lymphadenopathy. Hypervascularity and progressive enhancement can be seen in the majority of tumors.

Heterotopic ossification in lymph node metastasis after rectal cancer resection: a case report and literature review

BackgroundHeterotopic ossification (HO) is the formation of osseous tissue outside the skeleton. HO in malignant tumors of the digestive tract is extremely rare, as is ossification in metastatic lesions from HO-negative digestive tract tumors. Regarding the pathogenesis of HO, two theories have been proposed. The first is that the osteoblastic metaplasia of tumor cells (driven by the epithelial-mesenchymal transition, EMT) results in HO, and the second is that factors secreted by cancer cells lead to the metaplasia of stromal pluripotent cells into osteoblasts. However, the osteogenic mechanisms remain unclear.Case presentationAn 83-year-old Japanese woman underwent low anterior rectal resection for rectal cancer before presentation at our institution, in June 2018. The final diagnosis was stage IIB rectal adenocarcinoma (T4aN0M0). Histological examination did not reveal HO in the primary tumor. Thirteen months after the operation, a solitary metastatic lesion in the brain 20 mm in size and a solitary metastatic lesion in a right axillary lymph node 20 mm in size were diagnosed. The patient was treated with gamma-knife therapy for the brain metastasis. One month later, she was referred to our institution. She underwent lymph node resection. Histological examination revealed that most portions of the affected lymph node were occupied by metastatic tumor cells and that central necrosis and four small ossified lesions without an osteoblast-like cell rim were present in the peripheral region. Immunohistochemical analysis showed tumor cells positive for BMP-2, osteonectin, osteocalcin, AE1/AE3, TGF-β1, Gli2, Smad2/3, and CDX2 and negative for nestin, CD56, and CK7.ConclusionThis is the first English case report of HO in a metachronous metastatic lymph node after the curative resection of HO-negative rectal cancer. Unlike HO lesions in past reports, the HO lesion did not show peripheral osteoblast-like cells, and the immunohistochemical findings indicated that the present case resulted from the EMT.

Ovary Lesions in Classical Hodgkin’s Lymphoma

Hodgkin’s lymphoma is a tumor characterized by predominant lesions in lymph nodes. Primary extranodal lesions are exceedingly rare. In the now available world literature, there are only single observations of classical Hodgkin’s lymphoma with ovary involvements. The present paper reports the diagnosis and treatment of a patient with classical Hodgkin’s lymphoma with ovary involvements confirmed by histological and immunohistochemical analyses.

Comparative Pathomorphology of Lymph Node Changes in Kikuchi-Fujimoto and Autoimmune Diseases with Lymphadenopathy: Own Experience

Background. Pathomorphological analysis of lymph node tissues in immune-mediated lymphadenopathies commonly presupposes differential diagnosis with tumors of lymphoid and myeloid tissues with partial lesions in lymph nodes. Besides, further study is required on pathogenetic relationship between autoimmune diseases with lymphadenopathy and Kikuchi-Fujimoto disease (KFD) with morphological substrate characterized by histiocytic necrotizing lymphadenitis. Aim. To compare, based on biopsy material, morpho-immunohistochemical characteristics of changes in lymph node tissues in patients with pathomorphological diagnosis of KFD and in patients with autoimmune diseases with lymphadenopathy, i.e. systemic lupus erythematosus (SLE) and adult Still's disease (ASD). Materials &amp; Methods. Morphological and immunohistochemical analyses were carried out on lymph node biopsies of 20 patients, 16 out of them with KFD (men/women 15:1, median age 26.5 years, range 18-47 years; in 44 % of cases lesions were only in cervical lymph nodes). In 2 female patients (aged 19 and 33 years) SLE was diagnosed based on clinical and laboratory data, and 2 patients (a woman aged 43 years and a man aged 25 years) were diagnosed with ASD. Results. Morphological and immunohistochemical analyses detected three major cell populations similar in KFD and SLE and probably reflecting pathogenetic relationship of these diseases: histiocytes expressing myeloperoxidase (MPO+), CD123+ plasmacytoid dendritic cells, cytotoxic CD8+ T-cells, and granzyme B+. In 55 % of KFD cases and 2 SLE cases there were many activated CD30+ lymphoid cells clustered and scattered in the areas of cytotoxic T-cells. Conclusion. To exclude SLE during subsequent additional examination of patients with morphological substrate characterized by histiocytic necrotizing lymphadenitis it is reasonable to use the term “Kikuchi-like changes” instead of KFD. When the data of immunohistochemical analysis in KFD, SLE, and ASD patients are compared, MPO+ histiocytes in lymph node tissue can serve as diagnostic immunohistochemical marker of immunoinflammatory process. If they are detected, differential diagnosis with myeloid sarcoma is required. CD30 expression by activated cytotoxic lymphoid cells was identified in SLE and in 55 % of KFD cases, which is another important common diagnostic characteristic of the substrate of two diseases (KFD and SLE) and requires differential diagnosis with anaplastic large-cell lymphoma and Hodgkin's lymphoma. Within the analyzed group of 20 patients morphological substrate of lymph nodes in 2 ASD patients differed in its morphological and immunohistochemical parameters from that in KFD and SLE patients and was characterized by expanded paracortex and morpho-immunohistochemical characteristics of extrafollicular B-cell activation.

Study on role of cytology in diagnosis of head and neck lesions in a tertiary care hospital

Background: Head and neck lesions are commonly encountered in patients across all age groups. This region encompasses a multitude of congenital, inflammatory or neoplastic lesions. FNAC is a clinically appropriate procedure associated with minimal trauma and complications for patients for analysis of head and neck swellings because of factors such as easy approachability of the target site, increased compliance and helping to avoid surgery in non-neoplastic lesions, inflammatory conditions and also some tumors. Objective: This study is undertaken to assess the accuracy of cytopathological diagnosis of head and neck lesions by FNAC and to correlate and analyze FNAC of head and neck lesions with that of histopathological study. Material and Methods: The present study was Laboratory based Cross sectional descriptive type of observational study. A total of 100 cases undergoing FNAC among the head and neck lesion were enrolled for present study. FNAC was done using 10 cc disposable syringe and 22/23 gauge needle taking all aseptic precautions. Both aspiration and non-aspiration techniques were used wherever required. Smears were stained with PAP, Haematoxylin-Eosin stain and Leishman stain. Zeihl-Neelsen staining for acid fast bacilli was done in suspected tubercular lesions. Results: Out of 100 patients lymph node lesions (46%) was the predominant site of FNAC. Out of 46 lesions of Lymph node; tubercular lymphadenitis was the most common pathological findings. Among 28 thyroid lesion Colloid goitre (45.5%) was the predominant finding. Out of 18 salivary gland lesions the most common lesion was pleomorphic adenoma. Out of 14 soft tissue and miscellaneous lesions benign lesions were commonest finding. Conclusion: FNAC is a simple, rapid and cheap diagnostic tool that can be done as an outpatient procedure with overall accuracy rate of more than 90 % which differentiates non-neoplastic lesions from neoplastic lesions thus avoiding unnecessary surgeries.

Cytological Evaluation Of Enlarged Lymphnodes In Metastatic Disease

Introduction: Lymphnodes are common site of metastases for different cancers. Thus, clinical recognition and urgent diagnosis of palpable lymphadenopathy is of paramount importance; specially to differentiate between inflammatory lesions from neoplastic lesions. Fine needle aspiration cytology (FNAC) of the lymph node is a simple diagnostic tool to diagnose suspected and unsuspected lymph node malignancy.Aims–To find out the role of FNAC in the diagnosis of metastatic lesions of lymphnode and whenever possible, for typing of tumor.Material &Method– A total 900 patients, who presented with lymphadenopathy were studied at AMC MET medical College and L.G hospital, Ahmedabad, Gujarat for a period of 2 years. FNAC of enlarged lymphnode was performed and stain with hematoxylin and eosin.Results- Out of total 900 cases studied, 785 were benign and 95 were malignant lesions. Twenty cases were inconclusive. Among the malignant lesions, 80 cases were found to be metastatic lesions. Maximum numbers of metastatic lesions were found in cervical lymphnodes and metastatic squamous cell carcinoma was the most common lesion followed by metastatic adenocarcinoma.Conclusion- FNAC is a simple, rapid, accurate and non-expensive diagnostic technique which can be used for the initial diagnosis of metastatic lymphadenopathy. It can give significant clue to detect the primary site of the tumor in cases with hidden malignancy, who are presented with metastatic lymphadenopathy as an initial sign. Therefore, FNAC is a useful tool in diagnosing metastatic lesion of lymphnodes.

多模态超声技术在浅表淋巴结病变良恶性鉴别诊断中的应用价值

多模态超声技术在浅表淋巴结病变良恶性鉴别诊断中的应用价值

Automatic Recognition and Classification System of Thyroid Nodules in CT Images Based on CNN.

Thyroid nodule lesions are one of the most common lesions of the thyroid; the incidence rate has been the highest in the past thirty years. X-ray computed tomography (CT) plays an increasingly important role in the diagnosis of thyroid diseases. Nonetheless, as a result of the artifact and high complexity of thyroid CT image, the traditional machine learning method cannot be applied to CT image processing. In this paper, an end-to-end thyroid nodule automatic recognition and classification system is designed based on CNN. An improved Eff-Unet segmentation network is used to segment thyroid nodules as ROI. The image processing algorithm optimizes the ROI region and divides the nodules. A low-level and high-level feature fusion classification network CNN-F is proposed to classify the benign and malignant nodules. After each module is connected in series with the algorithm, the automatic classification of each nodule can be realized. Experimental results demonstrate that the proposed end-to-end thyroid nodule automatic recognition and classification system has excellent performance in diagnosing thyroid diseases. In the test set, the segmentation IOU reaches 0.855, and the classification output accuracy reaches 85.92%.

A survey of Prototheca bovis infection in dairy farms of the Hubei province, China.

Bovine mastitis, caused by Prototheca bovis, has received much attention worldwide. To investigate the status of P. bovis infection in dairy farms of Hubei, we collected 1,158 milk samples and 90 environmental samples from 14 dairy farms of Hubei, China. The isolates were identified with traditional biological methods and molecular biological techniques, and their pathogenicity was tested through mice infection experiments. Isolates from 57 milk and 20 environmental samples were identified as P. bovis. The mice infection tests proved that the isolated P. bovis could cause mastitis in mice, manifesting as severe red swelling of the mammary glands. Histopathological analysis of tissue sections showed necrosis and nodules lesions formed in the infected mice mammary tissue, accompanied by macrophage and neutrophil infiltration. These results suggested the existence of pathogenic P. bovis in dairy farms of the Hubei province, China, with brewer’s grains and fresh feces possibly playing important roles in the spread of this disease.

Evaluation of Treatment Effectiveness of Lymphoma with Impairment of Peripherall Lymph Nodes by Ultrasonic Elastography

Purpose: To evaluate the capabilities of ultrasound elastography in assessing the effectiveness of treatment of patients with special lesions of peripheral lymph nodes in lymphoproliferative lesions.Material and methods: To evaluate the capabilities of ultrasound elastography in assessing the effectiveness of treatment, an ultrasound study was carried out for 93 patients with lesions of peripheral lymph nodes with lymphoma in dynamics before treatment and after 2/3 courses of chemotherapy using Acoustic Force Radiation Impulse (ARFI — shear wave elastography) and eSie Touch (compression elastography).Results: Assessment of the dynamics of the average, minimum and maximum values of the shear wave velocity showed statistically significant differences. The most reliable changes were recorded when assessing the average and maximum indicators of the shear wave velocity (p = 0.0000001). Also, after two / three cycles of chemotherapy, the indicator X, XX m/s (p = 0.00001) was significantly less frequent, which was previously detected in the LN with the most rigid structure. Compression ultrasound elastography revealed softening of the LN structure in the form of an increase in the frequency of occurrence of I and II elastotypes.Conclusions: Our study confirms that ultrasound elastography allows, in a short time and without negative ionizing effects on the patient, to assess the effectiveness of the selected chemotherapy routes.

Reversal reaction with nodules that initially diagnosed as erythema nodosum leprosum in borderline lepromatous leprosy

Background:&nbsp; The reversal leprosy reaction generally manifest as larger, swollen, red and shiny the pre-existing skin lesions which are accompanied with pain. This reaction can be manifest as infiltration and nodules which resembles the features of erythema nodosum leprosum (ENL)&nbsp; leprosy&nbsp; reaction.&nbsp; Case Illustration:&nbsp; We present a case of 26-year-old woman with erythematous nodules on almost all the body since two weeks&nbsp; ago. She had&nbsp; pre-existing erythema plaque on the right elbow became more erythematous and arouse with partially felt pain, fever, and malaise. Nodule lesions in BL leprosy with reaction need to be distinguished between ENL and reversal reaction&nbsp; because&nbsp; they may affect therapy and prognosis.&nbsp;&nbsp; Discussion:&nbsp; T he patient was diagnosed as BL leprosy with ENL reaction e rythematous nodules on the face, both upper and lower arms, upper and lower limbs, knees, that &nbsp; partially&nbsp; felt&nbsp; pain , but after more careful history and histopathologic examination of the lesions, the nodules didn&rsquo;t match to the histopathologic features of ENL reaction. Correlation between the clinical and histopathological findings in the form of acid fast bacilli (AFB) and&nbsp; granulomatous inflammation grenz zone with epithelioid cells and lymphocyte cells infiltrations in the dermis&nbsp; established the diagnosis of BL leprosy with reversal reaction .&nbsp; Conclusion:&nbsp; Erythema nodule lesions in leprosy can be an ENL or reversal reaction or a leprosy lesion in type BL leprosy. &nbsp; Reversal reaction&nbsp; should always be considered when diagnosing a skin-colored nodule in leprosy.&nbsp; Appropriate clinical and histopathological findings of the&nbsp; skin-colored &nbsp;nodules are needed&nbsp; to establish the definite diagnosis of reversal reaction. &nbsp; Keywords: &nbsp;leprosy, borderline lepromatous, n odule, reversal reaction, erythema nodosum leprosum

The utility of Fine Needle Aspiration Cytology in the Diagnosis of Lymphadenopathy

Introduction: The causes of lymphadenopathy may be varied ranging from reactive to neoplastic.Fine Needle Aspiration Cytology(FNAC) is a simple and inexpensive diagnostic tool to sample cellsfrom superficial and accessible sites. Aims: This study was undertaken to assess the utility of FNACin evaluating lymphadenopathy and to study the cytomorphological spectrum of lymph node lesionsin our region. Settings and Design: A cross-sectional study of two years duration, on patients withlymphadenopathy who came to the Pathology Department for FNAC. Methods and materials:Cytology findings of Lymph node lesions were classified into four categories and were compared withhistopathology diagnosis as the gold standard. Statistical Analysis: Data was tabulated accordingto various parameters. Sensitivity, Specificity, PPV, NPV, and Diagnostic accuracy for detectingmalignancy were calculated. Results: The age range of patients included in the present studyranged from 9 to – 78 years. The mean age is 48.92 years and the median is 52 years. Thecytological diagnosis was classified as reactive in 20 cases (32.7%), inflammatory in 16 cases(26.2%), lymphoma in 3 cases (4.9%), and 22 cases (36.1%) were metastasis from other sites.Following histopathology, the cases were diagnosed to be 19 reactive lymphadenopathies, 14inflammatory lesions, 5 lymphomas, and 23 metastasis. The most common site of lymphadenopathywas the cervical region. Conclusions: FNAC has high sensitivity and specificity in differentiatingbenign lesions from malignant ones. The age, clinical findings, and supporting investigations shouldbe taken into account while diagnosing a lesion as benign or malignant.

Embryonal rhabdomyosarcoma with distant spinal cord metastasis: case and MR-imaging

Embryonal rhabdomyosarcoma (eRMS) is one of the most common soft tissue sarcomas in children, accounting for 4.5% of all childhood tumors. Half of the eRMS occuring in the head and neck are parameningeal. About 40% of patients with eRMS can develop distant metastases. In patients with intracranial tumors, metastatic spread can occur along the central nervous system (CNS) meninges. The literature describes only 4 clinical cases of eRMS with distant metastases in the spinal cord and along the meninges. Only in two out of these four cases, CSF cytology was positive (meaning that tumor cells were detected in cerebrospinal fluid). Magnetic resonance imaging (MRI) of the central nervous system with contrast enhancement can be used to detect distant metastases in the CNS and meninges. We present a clinical case of a 4-year old girl with parameningeal eRMS. MRI of the CNS performed as part of a diagnostic check-up revealed nodal metastatic foci along the meninges of the spinal cord. In accordance with the treatment protocol, the patient was diagnosed with stage 4 disease and received intensive polychemotherapy resulting in the disappearance of the nodal lesions in the spinal cord and a good prognosis. The parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.