Malignant Lymphadenopathy Research Articles

Contrast-enhanced endoscopic ultrasound for swollen lymph nodes.

Endoscopic ultrasound (EUS) is an important tool for the evaluation of lymphadenopathy, especially in intra-thoracic or intra-abdominal regions. EUS also provides tissue diagnosis via EUS fine-needle aspiration or biopsy. To select the target for biopsy or aspiration, conventional B-mode images are used for the evaluation, but this approach still lacks diagnostic accuracy. Contrast-enhanced EUS has been used to evaluate the vascularity of lesions. Most malignant lymphadenopathy shows heterogenous enhancement or defect of enhancement, while quantitative studies using time-intensity curves in contrast-enhanced harmonic EUS show a rapid decline in enhancement pattern. These findings are useful as an auxiliary method for tissue diagnosis or in cases in which tissue diagnosis is contraindicated.

Diffusion tensor imaging in characterization of cervical lymphadenopathy

BackgroundIt is important to differentiate cervical lymph nodes. So, this study aims to assess the ability of diffusion tensor imaging (DTI) in differentiating cervical lymphadenopathy (LNs).Materials and methodsThis retrospective study was done upon 100 patients with cervical LNs who had DTI over a year period. The fractional anisotropy (FA) and the mean diffusivity (MD) values of LNs were measured.ResultsThis study was done upon 100 patients (the mean age 45 ± 2 years (standard deviation [SD]), 63 men). The mean MD and FA of the malignant LNs (0.83 ± 0.14 × 10−3 mm2/s, 0.26 ± 0.07) were significantly different; (P = 0.001) than those of benign LNs (1.32 ± 0.33 × 10–3 mm2/s, 0.22 ± 0.09). MD of 0.94 × 10–3 mm2/s and FA of 0.21 were used to discriminate malignant and benign LNs, AUC 0.892 and 0.758, and 84% and 71% accuracy, respectively. Combined parameters revealed AUC of 0.914 and 81%. The mean MD and FA of the metastatic LNs (0.86 ± 0.12 × 10–3 mm2/s, 0.25 ± 0.07) were statistically different; (P = 0.001, 0.03) than those of lymphomatous nodes (0.66 ± 0.13 × 10–3 mm2/s, 0.28 ± 0.02). The AUC of the MD and FA used to distinguish metastatic from lymphomatous nodes was 0.82, 0.711, (0.71 × 10–3 mm2/s, 0.27) cutoff values, and 95.3%, 73.4% accuracy, respectively. Combined parameters revealed 0.824 AUC, 95.3% accuracy, 98.2% sensitivity, and 75% specificity. There was a significant statistical difference in MD between well-moderately (P = 0.001) versus poorly differentiated metastatic LNs and stages I and II (P = 0.018) versus stages III and IV of metastatic cervical LNs.ConclusionsCombining FA and MD is a promising technique that can play a major role in distinguishing different categories of cervical LNs.

"Truffle sign". A suspicious malignant pattern of lymphadenopathies in children observed on ultrasound. Preliminary study.

The differential diagnosis of lymphadenopathies in children including benign and malignant conditions is often difficult to identify by ultrasound (US). The lymphadenopathies in children are frequent and mostly benign, therefore it is essential to decide what patients should undergo further studies. To describe the potential usefulness of a new suspicious ultrasound sign on pediatric lymphadenopathies that can orient the diagnosis of malignancy. We retrospectively reviewed all pediatric cases with lymphadenopathy suspicious of lymphoma or lymphoproliferative syndrome on soft tissue ultrasound from 2014 to 2021. Two expert ultrasound radiologists reviewed ultrasound images of these patients, associating the internal structure of infiltrated adenopathy with the internal structure of the truffles. On ultrasound, twelve cases presented enlarged lymphadenopathy with loss of internal structure, without hilum; mostly hypoechoic parenchyma, with some fine echogenic serpiginous linear surrounding hypoechoic pseudo nodular images, resembling the inner structure of black truffles. This US pattern looked suspicious and histological study was recommended. In 9 cases a lymphomatous infiltrated adenopathy was confirmed on biopsy. The truffle sign is a new potential suspicious ultrasound sign, that can suggest malignant lymphadenopathy in children. This ultrasound pattern can have some probable usefulness to the radiologist in order to recommend further studies, including histological study, that need to be validated by a larger sample. It is important to recognize easily and early the lymphomatous compromise in a lymph node.

A phase 1/2 study of combination olaparib and radium-223 in men with metastatic castration-resistant prostate cancer with bone metastases (COMRADE): A trial in progress.

TPS5110 Background: Radium-223, an α-emitting radioisotope inducing DNA double-stranded breaks leading to cell death has demonstrated improvement in overall survival (OS) in men with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. PARP inhibitors prevent the repair of DNA single-stranded breaks and have demonstrated clinical efficacy as monotherapy in mCRPC patients harboring alterations in the homologous recombination repair (HRR) pathway and in combination with androgen receptor signaling inhibitors irrespective of DNA repair mutation status. In preclinical models, PARP inhibitors have shown efficacy as radio sensitizing agents. We designed a phase 1/2 trial to identify the recommended phase 2 dose (RPD2) of olaparib and radium-223 and test the hypothesis that radium-223 + olaparib will demonstrate anti-tumor activity in mCRPC irrespective of homologous recombination repair deficiency (HRD) status (NCT03317392). Methods: This open-label, multicenter, phase 1/2 study evaluates the dosing, safety and efficacy of olaparib with radium-223 in men with mCRPC with bone metastases. The phase 1 component used a 3+3 dose escalation design to determine the olaparib recommended phase 2 dose (RP2D) + fixed dose radium-223 (55 kBq/kg IV every 4 weeks x 6). The phase 1 portion has completed accrual (n = 12) and demonstrated that the RP2D of olaparib is 200 mg by mouth twice daily when combined with standard dose radium-223. The phase 2 component of the study which was activated in 1/2021 is an open-label, randomized trial (1:1) evaluating olaparib + radium-223 compared to radium-223 alone. The inclusion criteria include patients with mCRPC with any number of prior therapy lines for mCRPC and ≥2 bone metastases by imaging and at least 1 lesion which has not been treated with prior radiation. Patients with visceral metastases or malignant lymphadenopathy ( > 4 cm in short diameter) are excluded. The primary endpoint for phase 2 is radiographic progression-free survival (rPFS) per PCWG3 guidelines for bone metastases and RECIST v1.1 for non-bone disease. The integrated biomarker is Oncopanel assay to determine HRR status. A key secondary endpoint will evaluate rPFS in biomarker positive and negative patients. Other secondary endpoints include time to PSA progression, PSA response, time to subsequent therapy, time to first skeletal event, and OS. Exploratory endpoints include WES/WTS of baseline biopsy tissue, assessment of RAD51 IHC and correlation with outcomes, ctDNA assessment and correlation with responses, evaluation of changes in the tumor immune microenvironment, and quality of life assessment. Target accrual is 133 patients. Clinical trial information: NCT03317392 .

Magnetic resonance imaging - evaluation of mesorectal lymphadenopathy in patients with rectal cancer.

Multidisciplinary management of patients with rectal cancer presents a gold standard of care; neoadjuvant therapy indications are based on magnetic resonance imaging (MRI) description of the local stage of the carcinoma. Although the accuracy of MRI-based assessment of cancer depth of invasion is satisfactory, its accuracy in the assessment of mesorectal lymphadenopathy is very questionable. This was a prospective, single-centre, cohort study focused on the accuracy of preoperative MRI in the assessment of mesorectal lymph nodes (LN). MRI findings of each patient were compared with detailed histopathological examination of rectal specimens. Forty patients with rectal cancer, undergoing rectal resection with total mesorectal excision were enrolled in the study. MRI assessment of the T-stage was correct in 22 of the 40 study patients (55.0%). T-stage overstaging was noted in 14 (35.0%), and understaging in 4 (10.0%) study patients. According to preoperative MRI (using Horvat's criteria), there were 50 suspicious/malignant lymph nodes. Only 13 of these 50 LNs (26.0%) were proved malignant on histopathology examination. In total, our study group included 18 patients with suspicious/positive LNs (according to preoperative MRI) who were classified as cN+. MRI diagnosis of malignant lymphadenopathy was correct in only 33.3% of these patients. MRI shows very low accuracy in the evaluation of mesorectal lymph nodes in patients with rectal cancer. Therefore neoadjuvant therapy should be offered particularly with respect to MRI description of the depth of carcinoma invasion (T-stage and relationship to fascia propria of the rectum).

Diffusion-weighted imaging in differentiating benign versus malignant lymphadenopathy

Background: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.

The role of ADC histogram analysis in the diagnosis of pediatric malignant lymphadenopathy

Aim: Lymphadenopathy (LAP) is one of the most common daily practice clinical findings in children. LAPs that involve more than one region and do not decrease with treatment are a significant cause of anxiety for clinicians and families. In this occurence, ultrasonography, which is the primary imaging method, is insufficient in some cases. Our aim is to make histopathological predictions with apparent diffusion coefficient (ADC) histogram analysis.
 Material and Method: A total of thirty-one patients, seventeen male and fourteen female, who underwent magnetic resonance imaging and were diagnosed histopathologically (with tru-cut or excisional biopsy) were included in our study. Magnetic resonance imagings were evaluated retrospectively. 
 Results: We could not differentiate lymphoma (when considered as a single group), granulomatous LAP and reactive lymphoid hyperplasia with an ADC histogram analysis (p>0.05). However, when the lymphoma subgroups were evaluated separately, we could only distinguish Burkitt’s lymphoma (with ADCmin values) from other pathologies (p

Comparison of Axillary Lymph Nodes on Breast MRI Before and After COVID-19 Booster Vaccination

Vaccine-related lymphadenopathy is a frequent finding following initial coronavirus disease 2019 (COVID-19) vaccination, but the frequency after COVID-19 booster vaccination is still unknown. In this study we compare axillary lymph node morphology on breast MRI before and after COVID-19 booster vaccination. This retrospective, single-center, IRB-approved study included patients who underwent breast MRI between October 2021 and December 2021 after the COVID-19 booster vaccination. The axillary lymph node with the greatest cortical thickness ipsilateral to the side of vaccination was measured on MRI after booster vaccination and before initial COVID-19 vaccination. Comparisons were made between patients with and without increase in cortical thickness of ≥ 0.2 cm. Continuous covariates were compared using Wilcoxon rank-sum test and categorical covariates were compared using Fisher's exact test. Multiple comparison adjustment was made using the Benjamini-Hochberg procedure. All 128 patients were included. Twenty-four of 128 (19%) displayed an increase in lymph node cortical thickness of ≥ 0.2 cm. Patients who received the booster more recently were more likely to present cortical thickening, with a median of 9 days (IQR 5, 20) vs. 36 days (IQR 18, 59) (p < 0.001). Age (p=0.5) and type of vaccine (p=0.7) were not associated with thickening. No ipsilateral breast cancer or malignant lymphadenopathy were diagnosed on follow-up. Axillary lymphadenopathy on breast MRI following COVID-19 booster vaccination is a frequent finding, especially in the first 3 weeks after vaccination. Additional evaluation or follow-up may be omitted in patients with low concern for malignancy.

Diagnostic Test Fine Needle Aspiration Biopsy (FNAB) Examination on Gold Standard Histopathological Tests for Identification of Colli Lymphadenopathy Patients at RSPAL. Dr. Ramelan Surabaya

Lymphadenopathy is a common clinical manifestation which requires rapid and accurate diagnosis. Fine Needle Aspiration Biopsy (FNAB) is used as an initial and direct diagnosis in cases of lymphadenopathy, confirmatory diagnosis of colli lymphadenopathy is carried out by histopathological examination. The purpose of this study was to determine the value of the FNAB diagnostic test for lymphadenopathy colli FNAB against the gold standard histopathology of Paraffin Blok for benign and malignant lymphadenopathy, examination data for Colli Lymphadenopathy obtained at RSPAL has never been studied before. This type of research is observational descriptive by taking medical record data (SIM-RS) of patients with lymphadenopathy in the colli region who were examined for FNAB and histopathology at the Anatomical Pathology Laboratory Installation, RSPAL dr. Ramelan Surabaya for the period January 2019 – March 2022. The sample used was selected using the total sampling method, obtained as many as 66 samples that met the inclusion criteria. The results of the FNAB examination were then matched against the histopathological gold standard examination data. Furthermore, the data was processed by 2x2 crosstabulation and diagnostic tests were carried out to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The results showed that the accuracy of the FNAB diagnostic test was 86.56%, sensitivity 80.48%, specificity 96.15%, positive predictive value 97.05%, negative predictive value 75.75%. In general, it can be stated that the FNAB examination can be a screening diagnostic tool that is easy, fast, relatively affordable and applicable in helping to establish the diagnosis of colli lymphadenopathy.

Role of Diffusion-Weighted Magnetic Resonance Imaging for Characterization of Mediastinal Lymphadenopathy.

To assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of mediastinal lymph nodes and compare them with morphological parameters. A total of 43 untreated patients with mediastinal lymphadenopathy underwent DW and T2 weighted MRI followed by pathological examination in the period from January 2015 to June 2016. The presence of diffusion restriction, apparent diffusion coefficient (ADC) value, short axis dimensions (SAD), and T2 heterogeneous signal intensity of the lymph nodes were evaluated using receiver operating characteristic curve (ROC) and forward step-wise multivariate logistic regression analysis. The ADC of malignant lymphadenopathy was significantly lower (0.873 ± 0.109 × 10-3 mm2/s) than that of benign lymphadenopathy (1.663 ± 0.311 × 10-3 mm2/s) (p = 0.001). When an ADC of 1.0955 × 10-3 mm2/s was used as a threshold value for differentiating malignant from benign nodes, the best results were obtained with a sensitivity of 94%, a specificity of 96%, and an area under the curve (AUC) of 0.996. A model combining the other three MRI criteria showed less sensitivity (88.9%) and specificity (92%) compared to the ADC-only model. The ADC was the strongest independent predictor of malignancy. The addition of other parameters failed to show any increase in sensitivity and specificity.

No association of malignant B-cell non-Hodgkin lymphomas with ipsilateral SARS-CoV-2 vaccination.

SARS-CoV-2 vaccines cause acute ipsilateral lymph node swelling in an important proportion of vaccines. Thus far, no malignant lymphadenopathies have been reported in temporal context to vaccination in the ipsilateral draining lymph node areas. Prompted by two cases with unilateral axillary lymphomas that occurred ipsilaterally to prior SARS-CoV-2 vaccination, we systematically retrieved all B-cell non-Hodgkin lymphomas at two German University Medical Centers diagnosed before and after introduction of SARS-CoV-2 vaccines in Germany. Available lymphoma tissue (n=19) was subjected to next-generation immunosequencing of the IGH locus. Malignant clonotypes were mined in the CoVabDab database and published data sets from 342 uninfected individuals, 55 individuals 28 days after anti-SARS-CoV-2 vaccination and 139 individuals with acute COVID-19 together encompassing over 1 million CDR3 sequences in total. Of 313 newly diagnosed cases in the two centers and observation periods, 27 unilateral manifestations in the defined deltoid draining regions were identified. The majority thereof were diffuse large B-cell lymphomas (18 of 27 cases). Eleven unilateral cases were diagnosed in the era of SARS-CoV-2 vaccination and 16 in the control period before introduction of such vaccines. Of the 11 unilateral lymphomas that occurred during the vaccination period, ten had received a SARS-CoV-2 vaccine prior to lymphoma diagnosis. These cases were further evaluated. While left-sided were more frequent than right-sided lymphomas (19 vs 8 cases), no statistically significant association of vaccination site and laterality of the lymphoma manifestation was found. The unilateral lymphomas showed a normal range of B-cell receptors typically found in these lymphoma subtypes with no evidence for anti-SARS-CoV-2 sequences in the malignant clonotype. Together, we found no evidence that the current SARS-CoV-2 vaccines could serve as a trigger for lymphomagenesis in the draining lymph node areas of the deltoid region used for vaccination.

Multispectral optoacoustic tomography to differentiate between lymph node metastases and coronavirus-19 vaccine-associated lymphadenopathy.

Worldwide mass vaccination for COVID-19 started in late 2020. COVID-19 vaccines cause benign hypermetabolic lymphadenopathies. Clinical stratification between vaccine-associated benign lymphadenopathies and malignant lymphadenopathies through ultrasound, MRI or FDG PET-CT is not feasible. This leads to unnecessary lymph node biopsies, excisions and even radical lymph node dissections. Therefore, to avoid unnecessary surgeries, we assessed whether noninvasive multispectral optoacoustic tomography (MSOT) enables a better differentiation between benign and malignant lymphadenopathies. All patients were vaccinated for COVID-19. We used MSOT to image deoxy- and oxyhaemoglobin levels in lymph nodes of tumour patients to assess metastatic status. MSOT imaging results were compared with standard ultrasound and pathological lymph node analysis. We also evaluated the influences of gender, age and time between vaccination and MSOT measurement of lymph nodes on the measured deoxy- and oxyhaemoglobin levels in patients with reactive lymph node changes. Multispectral optoacoustic tomography was able to identify cancer-free lymph nodes in vivo without a single false negative (33 total lymph nodes), with 100% sensitivity and 50% specificity. A statistically significant higher deoxyhaemoglobin content was detected in patients with tumour manifestations in the lymph node (p= 0.02). There was no statistically significant difference concerning oxyhaemoglobin (p= 0.65). Age, sex and time between vaccination and MSOT measurement had statistically non-significant impact on deoxy- and oxyhaemoglobin levels in patients with reactive lymph nodes. Here, we show that MSOT measurement is an advantageous clinical approach to differentiate between vaccine-associated benign lymphadenopathy and malignant lymph node metastases based on the deoxygenation level in lymph nodes.

Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic.

Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.

The Utility of the Ultrasonographic Characteristics in Differentiating Between Malignant and Tuberculous Mediastinal Lymphadenopathy During EBUS-TBNA.

Ultrasonographic characteristics may help differentiate between benign and malignant lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). There is limited data on the utility of various ultrasonographic lymph node features to differentiate between malignant and tuberculous mediastinal lymphadenopathy. We studied the various EBUS ultrasonographic lymph node characteristics (size, shape, margins, heterogeneous echotexture, calcification, central hilar structure, lymph node conglomeration, central intranodal vessel, and coagulation necrosis sign) from our available EBUS-TBNA database. We extracted 1086 subjects [547 with tuberculosis (TB) and 539 with malignant diagnosis]. Comparing the 2 groups (multivariate analysis), presence of central hilar structure (8.2% vs. 2.6%), coagulation necrosis sign (37.5% vs. 13.7%), lymph node conglomeration (30.5% vs. 7.2%), calcification (5.1% vs. 1.5%), and distinct margins (83.5% vs. 69.8%), were significantly more common in TB ( P <0.05). On the other hand, malignant lymph nodes were larger and more likely to show the presence of a central intranodal vessel (20% vs. 15.8%, P =0.04, multivariate analysis). The absence of lymph node conglomeration had the highest overall diagnostic accuracy (0.61) for the differentiation between malignant and tuberculous lymph nodes. Sonographic lymph node characteristics may help differentiate malignant and tuberculous mediastinal lymphadenopathy. Contrary to previously published literature, we observed coagulation necrosis sign, heterogeneous echotexture and absent central intranodal vessel, more commonly in TB than malignant nodes. These findings from a TB endemic setting are different from other settings, where the prevalence of lung cancer is high in patients undergoing EBUS-TBNA.

Role of color Doppler ultrasound in differentiation between benign and malignant lymphadenopathy

Objective To evaluate the accuracy of color Doppler ultrasound in differentiation between benign and malignant enlarged lymph nodes compared with histopathological correlation. Patients and methods In all, 100 patients with lymphadenopathy in various age groups participated in this prospective study. Grayscale and color Doppler ultrasound (CDUS) was done for all of them, and then a comparison with histopathological data was done. Results Grayscale ultrasound had 88.9% sensitivity and 100% specificity with an area under the curve of 0.94 in the prediction of malignant LNs, while CDUS had 100% sensitivity and 87.8% specificity with an area under the curve of 0.93, The pulsatile index at a cutoff point &gt;1.39 had 77.8% sensitivity and 100% specificity in the prediction of malignant LNs with an area under the curve of 0.87, while the resistive index at a cutoff point &gt;0.69 had 78% sensitivity and 100% specificity with an area under the curve of 0.89. Conclusion Differentiation between benign and malignant lymph nodes using CDUS is a reliable and noninvasive technique.

Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies. To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies. This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy. The specimens were defined as positive for malignancy, negative for non-malignancy (tuberculosis, sarcoidosis, etc.), and without a definitive diagnosis. Sensitivity, negative predictive value (NPV) for malignancy, and overall accuracy were calculated. Complications were recorded. A total of 80 patients underwent EBUS-TBNA and had a final diagnosis, among which 50 (62.5%) were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis, 14 (17.5%) were diagnosed with primary lung cancer with nodal involvement, and 16 (20.0%) exhibited benign behavior including tuberculosis, sarcoidosis and reactive lymphadenitis or who had benign follow-up. The diagnostic sensitivity, NPV, and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8% (n = 60/64), 80.0% (n = 16/20), and 95.0% (n = 76/80), respectively. In the multivariate analysis, longer short axis of the lymph node (OR: 1.200, 95%CI: 1.024-1.407; P = 0.024) and synchronous lung lesion (OR: 19.449, 95%CI: 1.875-201.753; P = 0.013) were independently associated with malignant intrathoracic lymphadenopathy. No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy, and no major complication was observed. EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.

Progressive Transformation of Germinal Centers Simulating Malignant Axillary Lymphadenopathy in a Breast Cancer Patient on FDG PET/CT.

A 64-year-old woman with breast cancer underwent FDG PET/CT for follow-up. The study revealed highly increased FDG uptake in newly diagnosed enlarged axillary lymph nodes, which were worrisome for malignancy. Histopathology revealed a rarely diagnosed benign disease of progressive transformation of germinal centers mimicking malignant lymphadenopathy. As imaging findings of this entity, which usually involves the axillary and cervical areas, have been reported in very few studies, nuclear medicine physicians should be familiar with this potential "false-positive" FDG uptake representing an interpretative pitfall, especially during evaluation of breast cancer patients.

Risk Factors for Death or Meningitis in Adults Hospitalized for Cutaneous Anthrax, 1950-2018: A Systematic Review.

Cutaneous anthrax accounts for approximately 95% of anthrax cases worldwide. About 24% of untreated patients die, and many cases are complicated by meningitis. Here, we explore clinical features of cutaneous disease associated with poor outcomes. A systematic review identified 303 full-text articles published from 1950 through 2018 that met predefined inclusion criteria. Cases were abstracted, and descriptive analyses and univariate logistic regression were conducted to identify prognostic indicators for cutaneous anthrax. Of 182 included patients, 47 (25.8%) died. Previously reported independent predictors for death or meningitis that we confirmed included fever or chills; nausea or vomiting; headache; severe headache; nonheadache, nonmeningeal signs; leukocytosis; and bacteremia. Newly identified predictors included anxiety, abdominal pain, diastolic hypotension, skin trauma, thoracic edema, malignant pustule edema, lymphadenopathy, and evidence of coagulopathy (all with P < .05). We identified patient presentations not previously associated with poor outcomes.

S2724 EBV as a Very Unusual Etiology of Mucocutaneous Ulcer of the Neo-Ileum in a Patient With Crohn's Disease

Introduction: A member of the herpes virus family, Epstein Barr virus (EBV) is one of the most common human viruses. It can cause latent infections in humans, leading to serious health complications, including lymphomas and lymphoproliferative disorders. Mucocutaneous ulcers associated with EBV (EBVMCU) are a recently established entity of the lymphoproliferative disorders in 2010. Case Description/Methods: An 82-year-old male with Crohn's disease s/p right hemicolectomy with the formation of neo-ileum seven years earlier, bladder cancer, lung cancer s/p lobectomy in remission for both cancers. He presented to the hospital complaining of bright red blood per rectum. He reports chronic loose stools attributed to a history of Crohn's disease and right hemicolectomy seven years earlier when 30 cm colon was removed, including terminal ileum to the proximal transverse colon. The patient reports that he believed his Crohn's was never symptomatic and was worried about the side effects of biologic Crohn's treatment, which he refused in the past. Colonoscopy revealed extensive ulceration at the neo-ileum with friable mucosa. The histology shows scattered large atypical EBV-positive cells of B cell lineage in inflamed and ulcerated mucosa with granulation tissue. A definitive diagnosis could not be made, and further biopsies were recommended. PET scan and CT scan were unremarkable for metabolically active malignant lesions or lymphadenopathy. Colonoscopy repeated two months later showed the same ulcerated lesion with the same histological features mentioned earlier. (Figure) Discussion: EBVMCUs manifest as shallow sharply circumscribed ulcers on the mucosa or skin and are histologically distinguished by the proliferation of variable-sized, atypical B-lymphocytes, making the site of the ulcers in the neo-ileum very atypical and unique. The lesion usually develops in individuals with impaired immunity, such as those who are elderly, have iatrogenic immunosuppression, have primary immune disorders, or are HIV/AIDS-infected. The lack of a tumor mass favors an EBV-positive mucocutaneous ulcer, a newly recognized entity that can involve the GIT and occurs as an age-related disease and in immunosuppressed patients. In contrast to other EBV-related lymphoproliferative disorders, such as EBV-positive diffuse large B-cell lymphoma, EBVMCU has a good prognosis. A watch-and-wait approach or reduction in immunosuppressants are usually sufficient to cause EBVMCU patients to achieve remission.Figure 1.: Neo-ileum biopsy: The atypical cells are large with ovoid to irregular nuclear membrane, hyperchromatic nuclei, variable prominent nucleoli, and cytoplasmic clearing.

A cytological study on peripheral lymphadenopathy in a tertiary care center with special reference to tuberculous lymphadenitis

Background: Fine-needle aspiration cytology (FNAC) is the most common, cost-effective, and time-efficient cytological diagnostic procedure and is used routinely in cases of swelling or lymph node enlargement at accessible sites. FNAC plays an important role in diagnosing benign and malignant lesions of peripheral lymphadenopathy cases and also provides a valuable screening test. Aims and Objectives: In this study, we aimed to evaluate various cytomorphological manifestations of lymphadenopathies and the suggestive cases of tuberculous lymphadenitis were divided based on their cytomorphological patterns. Materials and Methods: The current prospective study was conducted in the Department of Pathology, SSMC, Rewa, M.P. A total of 150 cases of peripheral lymphadenopathy were subjected to FNAC and were categorized based on their cytological findings. The cases which showed features suggestive of tuberculous lymphadenitis were further categorized into four distinct cytological patterns (I to IV). Results: Out of 150 cases of peripheral lymphadenopathies, the most common lesion diagnosed cytologically was reactive lymphadenitis (41.3%) followed by tuberculous lymphadenitis in 38.7% cases. The different patterns of tuberculous lymphadenitis on microscopy were divided into four categories from I to IV with pattern I being the most frequently seen (53.5%). Conclusion: Our study highlighted the various morphological patterns of lymphadenopathy and the most common lesion diagnosed was reactive lymphadenitis. The present study found that FNAC is an effective screening tool for diagnosing benign and malignant lymphadenopathies and also to study the cytomorphological patterns in cases of tuberculous lymphadenitis. It reduces the need for surgical intervention and for the early diagnosis and management of patients with peripheral lymphadenopathy.