Persistent Nodules Research Articles

Delayed allergic skin reactions to vaccines.

Background: Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. Objective: This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Methods: Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Results: Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Conclusion: Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.

Genital nodular scabies in Indonesian adolescent boy

<p class="abstract">Scabies is an infection caused by infestation and sensitization to the parasitic mite <em>Sarcoptes</em> <em>scabiei</em> <em>var</em>. <em>hominis</em>. World Health Organization (WHO) in 2017 declared that scabies was included as Neglected Tropical Diseases (NTD) and become a significant health concern in many developing countries. According to the Global Burden of Disease Study in 2015, Indonesia was the first place among 195 countries with the greatest scabies burden. Nodular scabies is an uncommon clinical variant in classical scabies cases, characterized by persistent pruritic nodules due to immune response against the mites and their products (eggs and scybala). This variant was occurring in about 7% of scabies patients. The incidence and prevalence of nodular scabies are still unknown. Nodular scabies is usually found in young children and affect the male genitalia, especially in the scrotum. The diagnosis of nodular scabies generally can be made clinically and supported by a history of receiving adequate anti-scabies treatment. Active infestation form or atypical manifestations of nodular scabies might be confused the diagnosis. Diagnostic tools such as dermoscopic and skin biopsy may aid in differentiating them. Histopathology features also can rule out the differential diagnosis. Corticosteroid (topical or injection) and topical inhibitor calcineurin (tacrolimus) was reported effective in treating nodular scabies. We reported an Indonesian adolescent boy who has been diagnosed with scabies complained of persistent pruritic nodules on his genital for several months despite adequate anti scabies therapy being given. Intralesional corticosteroid injection was the options treatment of this case due to the nodular lesion being resistant with topical corticosteroids, while topical tacrolimus is difficult to obtain in our region.</p>

The Impact of EGFR Tyrosine Kinase Inhibitor on the Natural Course of Concurrent Subsolid Nodules in Patients with Non-Small Cell Lung Cancer.

PurposeThe role of epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) in the management of persistent subsolid nodules (SSNs) is unclear. This study aimed to investigate the impact of EGFR-TKIs on concurrent SSNs in patients with stage IV non–small cell lung cancer (NSCLC).Materials and MethodsPatients who received an EGFR-TKI for at least 1 month for stage IV NSCLC and had concurrent SSN(s) that had existed for at least 3 months on chest computed tomography were included in this retrospective study. Size change of each nodule before and after EGFR-TKI therapies were evaluated using a cutoff value of 2 mm; increase (≥ 2 mm), decrease (≤ −2 mm), and no change (−2 mm < size change < +2 mm).ResultsA total of 77 SSNs, 51 pure ground-glass (66.2%) and 26 part-solid nodules (33.8%), were identified in 59 patients who received gefitinib (n=45) and erlotinib (n=14). Among 58 EGFR mutation analysis performed for primary lung cancer, 45 (77.6%) were EGFR mutant. The proportions of decrease group were 19.5% (15/77) on per-nodule basis and 25.4% (15/59) on per-patient basis. Four SSNs (5.2%) disappeared completely. On per-patient based multivariable analysis, EGFR exon 19 deletion positivity for primary lung cancer was associated with a decrease after initial EGFR-TKI therapy (adjusted odds ratio, 4.29; 95% confidence interval, 1.21 to 15.29; p=0.025).ConclusionApproximately 20% of the concurrent SSNs decreased after the initial EGFR-TKI therapy. EGFR exon 19 deletion positivity for primary lung cancer was significantly associated with the size change of concurrent SSNs.

Observations on presumptive lumpy skin disease in native cattle and Asian water buffaloes around the tiger reserves of the central Indian highlands

ABSTRACT Case history Between August and October 2020, following the monsoon, signs of Lumpy skin disease (LSD) were recorded and described in 154 oxen, 34 cows, 13 calves (Bos indicus ) and two Asian water buffalo (Bubalus bubalis) cows belonging to smallholder farmers in 32 villages located around the Kanha and Bandhavgarh tiger reserves in the state of Madhya Pradesh central India. Affected animals were subjected to a full clinical examination and detailed findings were recorded in a clinical register. A semi-structured questionnaire was attached to the existing clinical register format to gather information on the clinical disease history and animal husbandry practices relevant to the spread of LSD virus. Clinical findings The affected animals were between 4 months and 14 years of age (mean 6.4 (SD 2.5) years). Persistent high temperature, depression, anorexia, and characteristic round nodules (lumps) on the skin were reported. The nodules were 2–5 cm in diameter and spread over the face, ears, neck, back, perineum, scrotum, legs, tail, udder, and nasal and oral mucosa. Secondary complications of myiasis (n=39), mastitis (n=16) and ulcerative lesions on legs were noticed. Death was reported for one animal (0.5%). The affected animals' recovery times were variable (mean 18.4 (SD 2.7) days). There was a significant positive correlation between delay in initiating treatment and the duration of sickness. Reduction in milk yield of 30–55% was reported in Bos indicus cows. Diagnosis Clinical findings and treatment responses consistent with lumpy skin disease and its sequelae. Clinical relevance The presumptive LSD outbreak caused serious economic loss to the animal keepers. LSD is a new disease for India and in the absence of active immunisation, efficient vector control, animal movement control and stall-feeding practice, it will inevitably become endemic in the country. The severe impacts resulting from the introduction of a new disease to a previously unaffected country, highlights the need for iterative improvements in global transboundary disease surveillance. The value of clinical examination and recording of findings is demonstrated in the context of smallholder farming systems with limited access to laboratory diagnosis, which are common around the world. The description of an LSD outbreak in naïve populations of cattle and buffalo illustrates the need for increased awareness of the associated clinical signs and maintenance of high levels of biosecurity in hitherto disease-free countries.

Predicting the histological invasiveness of pulmonary adenocarcinoma manifesting as persistent pure ground-glass nodules by ultra-high-resolution CT target scanning in the lateral or oblique body position.

Ultra-high-resolution computed tomography (U-HRCT) has improved image quality for displaying the detailed characteristics of disease states and lung anatomy. The purpose of this study was to retrospectively examine whether U-HRCT target scanning in the lateral or oblique body position (protocol G scan) could predict histological invasiveness of pulmonary adenocarcinoma manifesting as pure ground-glass nodules (pGGNs). From January 2015 to December 2016, 260 patients with 306 pathologically confirmed pGGNs who underwent preoperative protocol G scans were retrospectively reviewed and analyzed. The U-HRCT findings of preinvasive lesions [atypical adenomatous hyperplasias (AAH) and adenocarcinomas in situ (AIS)] and invasive pulmonary adenocarcinomas [minimally invasive adenocarcinomas (MIA) and invasive adenocarcinomas (IAC)] were manually compared and analyzed using orthogonal multiplanar reformation (MPR) images. The logistic regression model was established to determine variables that could predict the invasiveness of pGGNs. Receiver operating characteristic (ROC) curve analysis was performed to evaluate their diagnostic performance. There were 213 preinvasive lesions (59 AAHs and 154 AISs) and 93 invasive pulmonary adenocarcinomas (53 MIAs and 40 IACs). Compared with the preinvasive lesions, invasive adenocarcinomas exhibited a larger diameter (13.5 vs. 9.3 mm, P=0.000), higher mean attenuation (-571 vs. -613 HU, P=0.002), higher representative attenuation (-475 vs. -547 HU, P=0.000), lower relative attenuation (-339 vs. -292 HU, P=0.000) and greater frequencies of heterogeneity (P=0.001), air bronchogram (P=0.000), bubble lucency (P=0.000), and pleural indentation (P=0.000). Multiple logistic analysis revealed that larger diameter [odds ratio (OR), 1.328; 95% CI: 1.208-1.461; P=0.000] and higher representative attenuation (OR, 1.005; 95% CI: 1.003-1.007; P=0.000) were significant predictive factors of invasive pulmonary adenocarcinomas from preinvasive lesions. The optimal cut-off value of the maximum diameter for invasive pulmonary adenocarcinomas was larger than 10 mm (sensitivity, 66.7%; specificity, 72.8%). The imaging features based on protocol G scanning can effectively help predict the histological invasiveness of pGGNs. The maximum diameter and representative attenuation are important parameters for predicting invasiveness.

Canine Synovial Sarcoma of the Stifle Joint with Pulmonary and Liver Metastases

A seven-year-old female mongrel dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital for second opinion regarding a progressive swelling of the right hind limb of two months duration. Clinical examination revealed a loss of body condition, tachypnea and tachycardia, a painful immobile solid mass of 20 cm x 14 cm x 10 cm located on the right stifle joint, leucocytosis, and anaemia. Radiographic examination of the joint revealed marked soft tissue swelling with amorphous areas of mineralization and complete destruction of the proximal tibia. Smooth and solid periosteal reaction was seen around the tibia and fibula with a Codman’s triangle. Multiple nodules and a mass with soft tissue opacity were seen in the lung fields. Post-mortem examination revealed separation of tibia and fibula, softening of the proximal parts of the tibia, and complete integration of the proximal region of the two bones and articular tissues into the surrounding muscular tissues. Multifocal nodular lesions of variable sizes were mostly found in the lungs and partly in the liver. Histologically, predominantly oval and round cells with variable nuclear sizes and moderate mitoses were observed in tissue samples from the joint, lungs and the liver although some parts of the lung metastases showed both round and spindle shaped tumor cells. Clinical profile is suggestive of aggressive biphasic (spindle and epithelial) type of synovial cell sarcoma with lung and liver metastasis. Early radiographic and biopsy examination of persistent musculoskeletal nodules is recommended for early diagnosis and interventions.

Post-Chemotherapy Histiocyte-Rich Pseudotumors: Radiologic and Endoscopic Mimics of Residual Lymphoma

Development of post-chemotherapy histiocyte-rich pseudotumor (PHP) is an underrecognized event following therapy in lymphoma patients and may mimic residual tumor using current therapy monitoring protocols. We report a series of 5 patients with PHP along with a review of the literature. In our series, we describe 3 patients with persistent hypermetabolic masses by positron emission tomography-computed tomography, one with persistent terminal ileal nodules on endoscopy, and one with bone marrow involvement, a site not associated with mass-like disease. Twenty-three patients with long-term follow-up were identified from our series and review of the literature. Forty-four percent of patients received additional therapy, and only 4% of patients died of lymphoma. This study illustrates that PHPs are not identified using current lymphoma therapy monitoring algorithms and may result in overtreatment with risk for additional therapy-related complications. The need for confirmatory tissue biopsy in this setting is recommended.

Subcutaneous Panniculitis-Like T-Cell Lymphoma in a Patient Receiving Long-Term Panniculitis Treatment: A Case Report

Subcutaneous panniculitis-like t-cell lymphoma (SPTL) is known as a rare type of cutaneous lymphoma characterized with penetration of neoplastic T cells to the subcutaneous tissue. It constituates less than 1% of all non-Hodgkin lymphomas. We described herein a 49-year-old woman with SPTL who presented with red-purple-colored persistent subcutaneous nodules disseminated on trunk and both extremities. The lesions were present for 15 years. She had been diagnosed as panniculitis and her lesions had not regressed with panniculitis treatment. SPTL was diagnosed due to histopathological examination of the lesions that revealed CD3 positive, CD8 positive, CD4 negative and CD56 negative atypical lymphoid infiltration with lobular and septal panniculitis-like pattern. SPTL must be always kept in mind as a differential diagnosis while examining biopsies of patients with panniculitis-like lesions resistant to long-term treatment. It is also important to remember that the biopsy material should be in such depth that involves subcutaneous fat tissue.

Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

Background/aimDespite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs).Materials and methods Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4].Results One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21–81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01).ConclusionWe recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

Association Between 18F-FDG PET/CT-Based SUV Index and Malignant Status of Persistent Ground-Glass Nodules.

To explore the association between 18F-FDG PET/CT-based SUV index and malignant risk of persistent ground-glass nodules (GGNs). We retrospectively analyzed a total of 166 patients with GGN who underwent PET/CT examination from January 2012 to October 2019. There were 113 women and 53 men, with an average age of 60.8 ± 9.1 years old. A total of 192 GGNs were resected and confirmed by pathology, including 22 in benign group and 170 in adenocarcinoma group. They were divided into three groups according to SUV index tertiles: Tertile 1 (0.14–0.54), Tertile 2 (0.55–1.17), and Tertile 3 (1.19–6.78), with 64 GGNs in each group. The clinical and imaging data of all patients were collected and analyzed. After adjusting for the potential confounding factors, we found that the malignancy risk of GGN significantly decreased as the SUV index increased (OR, 0.245; 95%CI, 0.119–0.504; P <0.001), the average probability of malignant GGN was 89.1% (95% CI, 53.1–98.3%), 80.5% (95% CI, 36.7–96.7%), and 34.3% (95%CI, 9.5–72.2%) for Tertile 1 to Tertile 3. And the increasing trend of SUV index was significantly correlated with the reduction of malignant risk (OR, 0.099; 95%CI, 0.025–0.394; P = 0.001), especially between Tertile 3 versus Tertile 1 (OR, 0.064; 95%CI, 0.012–0.356; P = 0.002). Curve fitting showed that the SUV index was linearly and negatively correlated with the malignant risk of GGN. SUV index is an independent correlation factor for malignancy risk of GGN, the higher the SUV index, the lower the probability of GGN malignancy.

EBER in situ hybridization in subcutaneous aluminum granulomas/lymphoid hyperplasia: A diagnostic clue to differentiate injection-associated lymphoid hyperplasia from other forms of pseudolymphomas and cutaneous lymphomas.

Subcutaneous vaccination or desensitization may induce persistent nodules at the injection sites. Without the knowledge of prior injection, histopathological work-up may be challenging. Aim of this study was to contribute to the histopathological work-up of unclear subcutaneous nodules, especially their differentiation from cutaneous lymphoma. We retrospectively reviewed clinical data and histopathological slides of four patients with subcutaneous nodules, which were suspected to suffer from cutaneous T- or B-cell lymphoma. Sections of these cases and 12 negative controls were stained with hematoxylin and eosin and a standardized immunohistochemical panel of B- and T-cell markers including EBER in situ hybridization as well as electron microscopy. In all cases, large histiocytes with granular cytoplasm compatible with intracellular aluminum hydroxide were present. EBER in situ hybridization revealed positive staining of these granular histiocytes while staining was absent in negative controls. Post hoc completion of medical history revealed that vaccination or specific immunotherapy had been applied before at the biopsy site in only three out of four patients; one patient was lost to follow-up. EBER in situ hybridization is an adjunctive tool to differentiate aluminum-induced granuloma/lymphoid hyperplasia from other forms of pseudolymphoma and cutaneous B- or T-cell lymphomas.

High frequency ultrasound assessment of labial glands simulating small nodules or granulomas after lip augmentation.

Aim of the studyThe aim of this study is to evaluate the utility of high-frequency ultrasound in the assessment of the nature and differentiation of lumps occurring in the labial mucosa after lip filling procedures.Material and methodsThe study sample included 5 women aged from 28 to 43 years (mean age: 37.4 years) who previously underwent a lip augmentation or rejuvenation procedure. Photographic documentation was taken and high-frequency ultrasound assessment was performed in all the patients. The presence of deposits, foreign body granulomas, fibrosis and labial glands was mainly investigated taking into account the shape of the abnormalities, their margins, surface area, location and echogenicity. In order to confirm the diagnosis, histopathological examination was performed.ResultsThe examinations performed made it possible to differentiate between granulomas and persistent deposit nodules and to demonstrate the presence of massive fibrosis and of labial glands pushed out by these abnormalities with the glands presenting as hypoechoic oval areas. Histopathological examination confirmed the morphology of labial glands reported by the patients as uncomfortable lumps felt from the side of the mucosa, which clinically simulate persistent deposit nodules or granulomas.ConclusionsHigh-frequency ultrasound is a method that is essential for the correct differentiation between complications of tissue filler procedures. This, in turn, makes it possible to apply the right treatment. In this study, it was demonstrated for the first time that the lumps reported by patients who have had a lip filling procedure may be the result of labial glands being pushed out by deposits, granulomas or massive fibrosis, which are complications of such procedures.

Prx1-expressing cells contributing to fracture repair require primary cilia for complete healing in mice.

Bone is a dynamic organ that is continuously modified during development, load-induced adaptation, and fracture repair. Understanding the cellular and molecular mechanisms for natural fracture healing can lead to therapeutics that enhance the quality of newly formed tissue, advance the rate of healing, or replace the need for invasive surgical procedures. Prx1-expressing cells in the periosteum are thought to supply the majority of osteoblasts and chondrocytes in the fracture callus, but the exact mechanisms for this behavior are unknown. The primary cilium is a sensory organelle that is known to mediate several signaling pathways involved in fracture healing and required for Prx1-expressing cells to contribute to juvenile bone development and adult load-induced bone formation. We therefore investigated the role of Prx1-expressing cell primary cilia in fracture repair by developing a mouse model that enabled us to simultaneously track Prx1 lineage cell fate and disrupt Prx1-expressing cell primary cilia in vivo. The cilium KO mice exhibited abnormally large calluses with significantly decreased bone formation and persistent cartilage nodules. Analysis of mRNA expression in the early soft callus revealed downregulation of osteogenesis, Hh signaling, and Wnt signaling, and upregulation of chondrogenesis and angiogenesis. The mutant mice also exhibited decreased Osx and Periostin but increased αSMA and PECAM-1 protein expression in the hard callus. We further used a Gli1LacZ reporter and found that Hh signaling was significantly upregulated in the mutant callus at later stages of healing. Interestingly, altered protein expression and Hh signaling did not correlate with labeled Prx1-lineage cells, suggesting loss of cilia altered Hh signaling non-autonomously. Overall, cilium KO mice demonstrated severely delayed and incomplete fracture healing, and our findings suggest Prx1-expressing cell primary cilia are necessary to tune Hh signaling for proper fracture repair.

S2268 A Unique Extra-Intestinal Manifestation of Ulcerative Colitis: Pulmonary Necrobiotic Nodules

INTRODUCTION: Ulcerative colitis (UC) can have a variety of extra-intestinal manifestations, some of which include pulmonary complications. They can range from interstitial lung disease, organizing pneumonia, to necrobiotic nodules. Necrobiotic nodules are sterile aggregates of inflammatory cells with necrosis. The appearance of these nodules can mimic other cavitating diseases, making them a diagnostic challenge. CASE DESCRIPTION/METHODS: A 25-year-old man with a PMH of UC (on mesalamine and non-compliant with steroid suppositories) presented from an outside hospital (OSH) with fevers, abdominal pain, and bloody diarrhea for 1 week. Imaging from OSH revealed diffuse colitis as well as several pulmonary nodules. Repeat imaging at our institution, showed multiple necrotic, cavitary pulmonary nodules, initially concerning for septic emboli and the patient was started on empiric antibiotics. The patient denied any history of drug abuse, cardiac history, or dental procedures. On physical exam, there was tenderness to palpation in bilateral lower quadrants of the abdomen with no rebound tenderness, and no murmurs. Laboratory markers were significant for elevated ESR, CRP, and fecal calprotectin. Infectious etiologies were negative for bacterial, viral and fungal pathogens, and stool studies were negative as well. Cardiac MRI and TTE did not show any vegetation, and blood cultures showed no growth. Further pertinent testing was negative for vasculitis and autoimmune etiologies such as granulomatosis with polyangiitis, and rheumatoid arthritis. A CT guided lung biopsy revealed fibrosis with mixed inflammatory infiltrate containing macrophages, lymphocytes, scatter neutrophils and plasma cells. After poor follow up and not initiating any immunosuppressants, symptoms returned one month later, and imaging showed persistent pulmonary nodules. The patient was then started on steroids and subsequently bridged to biologic agents and symptoms improved. DISCUSSION: This case illustrates a rare manifestation of necrobiotic pulmonary nodules in a patient with poorly controlled UC. Before making this diagnosis, a thorough, yet pertinent differential such as malignancy, septic emboli, vasculitis, and infectious etiologies must be excluded. There are only two case reports of this UC complication. One patient was treated with a course of prednisone and imaging showed resolution of the nodules.Figure 1.: CT Chest With IV Contrast Showing Multiple Lung Nodules, Several Necrotic and Demonstrating Cavitation.

Persistent pulmonary subsolid nodules with a solid component smaller than 6 mm: what do we know?

Persistent pulmonary subsolid nodules with a solid component smaller than 6 mm: what do we know?

Discrimination between transient and persistent subsolid pulmonary nodules on baseline CT using deep transfer learning

To develop and validate a deep learning model to discriminate transient from persistent subsolid nodules (SSNs) on baseline CT. A cohort of 1414 SSNs, consisting of 319 transient SSNs in 168 individuals and 1095 persistent SSNs in 816 individuals, were identified on chest CT. The cohort was assigned by examination date into a development set of 996 SSNs, a tuning set of 212 SSNs, and a validation set of 206 SSNs. Our model was built by transfer learning, which was transferred from a well-performed deep learning model for pulmonary nodule classification. The performance of the model was compared with that of two experienced radiologists. Each nodule was categorized by Lung CT Screening Reporting and Data System (Lung-RADS) to further evaluate the performance and the potential clinical benefit of the model. Two methods were employed to visualize the learned features. Our model achieved an AUC of 0.926 on the validation set with an accuracy of 0.859, a sensitivity of 0.863, and a specificity of 0.858, and outperformed the radiologists. The model performed the best among Lung-RADS 2 nodules and maintained well performance among Lung-RADS 4 nodules. Feature visualization demonstrated the model's effectiveness in extracting features from images. The transfer learning model presented good performance on the discrimination between transient and persistent SSNs. A reliable diagnosis on nodule persistence can be achieved at baseline CT; thus, an early diagnosis as well as better patient care is available. • Deep learning can be used for the discrimination between transient and persistent subsolid nodules. • A transfer learning model can achieve good performance when it is transferred from a model with a similar task. • With the assistance of deep learning model, a reliable diagnosis on nodule persistence can be achieved at baseline CT, which can bring a better patient care strategy.

Radiological-pathological correlation of subsolid pulmonary nodules: A single centre retrospective evaluation of the 2011 IASLC adenocarcinoma classification system

IntroductionThe 2011 IASLC classification system proposes guidelines for radiologists and pathologists to classify adenocarcinomas spectrum lesions as preinvasive, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA). IA portends the worst clinical prognosis, and the imaging distinction between MIA and IA is controversial. Materials and methodsSubsolid pulmonary nodules resected by microcoil localization over a three-year period were retrospectively reviewed by three chest radiologists and a pulmonary pathologist. Nodules were classified radiologically based on preoperative computed tomography (CT), with the solid nodule component measured on mediastinal windows applied to high-frequency lung kernel reconstructions, and pathologically according to 2011 IASLC criteria. Radiology interobserver and radiological-pathological variability of nodule classification, and potential reasons for nodule classification discordance were assessed. ResultsSeventy-one subsolid nodules in 67 patients were included. The average size of invasive disease focus at histopathology was 5 mm (standard deviation 5 mm). Radiology interobserver agreement of nodule classification was good (Cohen’s Kappa = 0.604, 95 % CI: 0.447 to 0.761). Agreement between consensus radiological interpretation and pathological category was fair (Cohen’s Kappa = 0.236, 95 % CI: 0.054−0.421). Radiological and pathological nodule classification were concordant in 52 % (37 of 71) of nodules. The IASLC proposed CT solid component cut-off of 5 mm to distinguish MIA and IA yielded a sensitivity of 59 % and specificity of 80 %. Common reasons for nodule classification discordance included multiple solid components within a nodule on CT, scar and stromal collapse at pathology, and measurement variability. ConclusionSolid component(s) within persistent part-solid pulmonary nodules raise suspicion for invasive adenocarcinoma. Preoperative imaging classification is frequently discordant from final pathology, reflecting interpretive and technical challenges in radiological and pathological analysis.

Persistent pruritic subcutaneous nodules at injection sites and other delayed type hypersensitivity reactions to aluminium adsorbed vaccines in Irish children: A case series.

Persistent pruritic subcutaneous nodules at injection sites and other delayed type hypersensitivity reactions to aluminium adsorbed vaccines in Irish children: A case series.

What's New on Quantitative CT Analysis as a Tool to Predict Growth in Persistent Pulmonary Subsolid Nodules? A Literature Review.

Pulmonary subsolid nodules (SSNs) are observed not infrequently on thin-section chest computed tomography (CT) images. SSNs persisting after a follow-up period of three to six months have a high likelihood of being pre-malignant or malignant lesions. Malignant SSNs usually represent the histologic spectrum of pulmonary adenocarcinomas, and pulmonary adenocarcinomas presenting as SSNs exhibit quite heterogeneous behavior. In fact, while most lesions show an indolent course and may grow very slowly or remain stable for many years, others may exhibit significant growth in a relatively short time. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored. In order to solve these two open issues, the use of quantitative analysis has been proposed to define the “tailored” management of persistent SSNs. The main purpose of this review was to summarize recent results about quantitative CT analysis as a diagnostic tool for predicting the behavior of persistent SSNs. Thus, a literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases to find original articles published from January 2014 to October 2019. The results of the selected studies are presented and compared in a narrative way.

Ulcerated nodules in a sporotrichoid distribution

A 42-year-old man presented with a 3-month history of persistent ulcerated nodules (Fig 1). History was relevant for deployment to the Middle East, Africa, Turkey, and South East Asia. He also reported skinning squirrels and butchering hogs on his farm in Missouri. Review of systems found intermittent fevers and night sweats. Prior treatment included multiple oral antibiotics without improvement. Examination found ulcerated, firm, pink nodules on the right forearm, elbow, and arm in sporotrichoid distribution without palpable lymphadenopathy.