Preauricular Node Research Articles

First report on parotid tissue choristomas within and adjacent to TMJ ligaments

PurposeTo report the first examples of ectopic salivary glands of TMJ ligaments & capsules. Methods and MaterialsNine subjects with chronic TMJ disorders were found incidentally to have ectopic salivary glands (choristomas) within or near damaged TMJ ligaments and capsules. Clinicopathologic characteristics of 12 TMJs are summarized. ResultsThe 9 subjects were ages 22-64 years (average = 43.0); 6 were female. Microscopic examination revealed major, almost complete ligament replacement by dense, avascular fibrous scar tissue in all but 1 sample. Chronic inflammatory cells were present in the stroma of 3 samples. A total of 33 lobular, independent salivary structures of variable sizes where embedded in or near ligaments and/or capsules. Half were multiple in the same joint; 13 were bilaterally located in the joints of a single subject, with 8 small glandular lobules in one TMJ. All glands consisted of histologically normal serous acini except 1 which showed a focal lobule of mucus acini and another comprised only of mucus acini. Serial sections showed no connection to parotid glands. Some choristomas showed the aging phenomena of fatty infiltrates (n = 7) and oncocytosis (n = 7). Additionally, 3 of the 12 TMJ samples contained preauricular lymph nodes, with 3 nodes in 1 joint and bilateral involvement in 1 subject. Of the 5 identified nodes, all but one was hyperplastic, with nonspecific inflammatory histiocytosis. ConclusionsWe report, for the first time, independent salivary gland choristomas (n = 33) within the soft tissues of the TMJ (n = 12), with one joint containing 8 such choristomas. All consisted of normal serous tissue except one, a mucus gland. Additionally, a fourth of TMJ surgical samples contained hyperplastic preauricular lymph nodes.

Lymphatic drainage patterns of malignant skin tumors in the head and neck region: a single-center retrospective study.

This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage patterns remain elusive. We statistically analyzed data of 47 patients with malignant skin tumors in the head and neck region. Information was collected on the patients' clinical characteristics, primary tumor site, and lymphatic drainage patterns. The parotid lymph nodes drained the greatest amount of lymph from skin tumors of the head and neck. Important lymphatic drainage pathways were the superficial cervical nodes for primary tumors in the buccal/nasal region, level IA and level IB nodes for primary tumors in the lip region, the occipital nodes, posterior auricular nodes, and level VA nodes in the parietal/occipital region, and the preauricular nodes in the auricular region. These findings have considerable significance in terms of understanding lymphatic drainage patterns for malignant skin tumors in the head and neck and may be useful for clinical decision-making and when planning treatment. Further research and clinical applications are expected to contribute to an improved prognosis in patients with cutaneous head and neck malignancies.

Viral Conjunctivitis

Viruses account for 80% of all cases of acute conjunctivitis and adenovirus; enterovirus and herpes virus are the common causative agents. In general, viral conjunctivitis spreads easily. Therefore, to control the spread, it is crucial to quickly diagnose illnesses, strictly implement hand washing laws, and sanitize surfaces. Swelling of the lid margin and ciliary injection are subjective symptoms, and eye discharge is frequently serofibrinous. Preauricular lymph node swelling can occasionally occur. Approximately 80% of cases of viral conjunctivitis are caused by adenoviruses. Adenoviral conjunctivitis may become a big global concern and may cause a pandemic. Diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment for adenovirus conjunctivitis. Although specific treatments are not always accessible, early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences.

Metastatic retinoblastoma at presentation: Clinical presentation, treatment, and outcomes.

The aim of this study was to retrospectively determine clinical features, treatment outcomes, and overall survival in four patients with metastatic retinoblastoma at presentation. The mean age at diagnosis was 63 months (range: 24-108 months). Three patients had overt orbital disease of at least one eye and one patient had microscopic orbital disease with scleral infiltration on histopathology. Metastatic sites included regional lymph nodes (RLN) (n = 4), bone marrow (BM) (n = 2), and cerebrospinal fluid (CSF) (n = 1). The most common sites of RLN were ipsilateral preauricular nodes (two patients) and contralateral parotid gland involvement (one patient). The treatment administered included primary enucleation (n = 1), high-dose intravenous chemotherapy (n = 4), secondary enucleation (n = 2), orbital external beam radiotherapy (n = 3), and intrathecal chemotherapy (n = 1). High-risk features included massive choroidal and microscopic scleral infiltration in the eye that underwent primary enucleation. At a mean follow-up of 33 months (range, 4-68 months), one patient with CSF involvement deceased in 4 months. The remaining three patients were alive and disease-free at the last mean follow-up period of 43 months (range, 18-68 months). The results of our study showed that RLN and BM metastasis respond well to treatment while CSF metastasis is associated with poor prognosis.

Parinaud's oculoglandular syndrome

Parinaud's oculoglandular syndrome (POGS) is a rare condition characterized by unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. Among all infectious agents, cat scratch disease (CSD), which is caused by Bartonella henselae, remains the commonest etiology agent of POGS. We present a case report of a 13-year-old boy who came to a tertiary center in Malaysia with left granulomatous conjunctivitis and subsequent necrotizing lesions involving left upper eyelid, left paranasal region, and left preauricular lymph nodes. With a poor initial treatment response and confusing investigation results, this interesting case describes the diagnostic dilemma in differentiating the etiological agents of POGS.

Malignant lesions of the caruncle.

Caruncle malignancy is rare, but signs of disease can be easily missed by both patients and clinicians. There is significant potential for significant morbidity and even mortality from delayed diagnosis and treatment. Clinical features of primary malignant cancer include rapid growth, pigment deposition, ulcerated surface and bleeding. Malignant diagnoses include lymphoproliferative disease, basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma and malignant melanoma. Increased pigmentation is associated with melanoma, yellow coloured deposition with sebaceous carcinoma and a salmon-pink hue with lymphoproliferative disease. Treatment involves excision with margin control which may necessitate exenteration. Metastases to cervical and preauricular lymph nodes has been reported.

Аденокарцинома сальной железы века

Sebaceous carcinoma belongs to rare malignant tumors of the eyelids, is characterized by a variety of clinical manifestations and is often disguised as other tumors or inflammatory diseases of the eyelids. The purpose of the work is to analyze the clinical picture and features of the course of sebaceous carcinoma. Material and methods. From January 2015 to December 2020, 6 patients were diagnosed with cancer of the sebaceous gland (5 patients with adenocarcinoma of the meibomian glands, 1 with adenocarcinoma of the Zeiss sebaceous glands). 4 were women and 2 were men aged from 59 to 89 years. Results. From the moment the first symptoms appeared to adequate treatment, 6-12 months passed. According to the 8th revision of the T-classification of malignant tumors of the AJCC eyelids, two patients had T2b, three had T3b, and one patient had T3c stage. A painless thickening of the eyelid cartilage and the eyelid margin was accompanied by the growth of yellowish dense masses on the conjunctiva in two women; the tumor spread to the eyelid skin in one patient. By the time the primary tumor was diagnosed, none of the patients had metastases to regional lymph nodes and hematogenous metastases. Wide excision of the tumor with simultaneous plastic surgery of the eyelid was performed in 4 patients. After excisional biopsy, 3 patients underwent local external beam radiation therapy to the area of the affected eyelid (Total dose 60 Gy.). Orbital exenteration was performed in two patients. The observation period for the patients: 3 months – 49 months. One patient died of a cause unrelated to the tumor. One patient died of metastases of Zeiss glands adenocarcinoma. Relapse of the tumor developed and metastasis to the preauricular lymph node appeared in one patient. Conclusion. Diagnosis of the sebaceous gland cancer of the eyelids is difficult, it is detected late. Ki67 does not depend on the size of the tumor, however, the large size of the tumor is an unfavorable factor in the prognosis of the disease. All patients with cancer of the sebaceous gland after treatment need to be followed up for at least 5 years with whole body PET/CT once a year. Key words: sebaceous carcinoma of the eyelids, adenocarcinoma of the meibomian glands, adenocarcinoma of the Zeiss sebaceous glands.

Indications for and extent of elective neck dissection for lymph node metastasis from external auditory canal carcinoma

ObjectivesWe aim to clarify the frequency of lymph node metastasis of external auditory canal (EAC) carcinoma, including susceptible locations, adequate extent of elective neck dissection, and the relationship between the tumor infiltration site and lymph node metastasis. Patients and MethodsFrom 2003 to 2018, 63 patients with EAC carcinoma at Tokyo Medical and Dental University Hospital were enrolled in this study. The T and N stages, locations of clinically positive lymph nodes, prognoses, and anatomic site of tumor infiltration were analyzed after treatment. ResultsClinically positive lymph node metastasis (cN+) was detected in 18 patients (28.6%), consisting of T1, T2, T3, and T4 disease in 1 (6%), 2 (22%), 8 (38%), and 7 (41%) patients, respectively. The metastatic locations were at level II in 10 patients, parotid gland nodes in 7, preauricular nodes in 5, level Ib in 3, level Va in 3, level III in 1, and superficial cervical nodes in 1. Neck recurrence was determined in two of 45 patients with clinically negative lymph nodes (cN0), with the metastatic locations being levels II, Ib, and III. Among 18 cN+ cases, neck recurrence was noted in 2 of 9 patients who underwent neck dissection. Neck lesions were found to be manageable in all five patients who underwent docetaxel, cisplatin, 5-fluorouracil, and radiation therapy (TPF-RT). No relationship was noted between the tumor infiltration site and lymph node metastasis among T3/4 canrcinoma patients. ConclusionsElective neck dissection could be indicated only in T3/4 patients with free flap reconstruction. Levels Ib to III are considered appropriate for elective neck dissection in cN0 cases. Levels Ib to III and Va indicated favorable sites, even in cases with metastasis in the parotid gland or preauricular area. Furthermore, TPF-RT could be a useful option even in cN+ cases.

Angiosarcoma of the scalp: What is the optimum management?

Scalp angiosarcoma is a rare malignancy with a poor outcome. In the absence of randomized trials, the approach to management depends on retrospective series and case reports. Here, we report a 56-year-old male diagnosed initially with squamous cell carcinoma of the scalp at an outside center. When he underwent re-excision for recurrence in our center, histopathology showed a high-grade angiosarcoma. He was offered postoperative radiotherapy for the primary site. During the treatment, he developed preauricular nodal recurrence, which was also treated with radiotherapy. After radiotherapy, he had persistent preauricular nodes, for which single-agent chemotherapy was given, and the nodes were regressed. However, the recurrence of preauricular nodes was noted at the next follow-up visit, and he was re-evaluated with a positron emission tomography-computed tomography scan, which showed an extensive lung and nodal metastases. He was started on metronomic chemotherapy and his disease was stable at the time of the last follow-up. This case raises several questions, including whether electively addressing the regional nodes in the scalp angiosarcoma could improve the outcomes, whether higher doses of radiotherapy are beneficial or only add to the toxicity of treatment, the role that chemotherapy plays and the most appropriate regimen. Although some relevant studies have been discussed in brief, more evidence is needed to answer these questions.

Viral conjunctivitis: a retrospective study in an Australian hospital

ImportanceTo update the literature on the current trends of viral conjunctivitis infections in Sydney, Australia. BackgroundTo find correlations between viral and patient characteristics on disease outcomes and to assess the rates of antibiotic and steroid use in patients with viral conjunctivitis prior to and after assessment by ophthalmology trainees. DesignRetrospective single-centre case series. Participants368 eyes of 224 patients diagnosed with viral conjunctivitis at the Sydney Eye Hospital from 1 st January - 31 st March 2017. MethodsPatients were identified from hospital records or polymerase chain reaction results. Results368 eyes of 224 patients, median age 35.3 (range 7–82) and 59.8% males, were included. 152 (67.9%) patients presented already on antibiotic treatment. Most patients (83.5%) had no previous ocular history aside from 35 (15.6%) who were regular contact lens wearers. PCR was performed in 170 (75.9%) patients, with 92 (54.1%) positive for adenovirus, and 7 (4.1%) for HSV. The average duration of symptoms prior to presentation was 6.3 days. 177 (78.0%) patients presented within 1 week of symptom onset and these patients were more likely to be adenovirus positive on PCR (OR = 2.37). Patients with symptoms of longer duration were more likely to have photophobia (OR = 2.96) and have had steroid treatment (OR = 3.80). Conclusions and relevancePatients with viral conjunctivitis typically presented within a week of symptom onset, with bilateral disease and on topical antibiotics. Pseudomembranes and a palpable preauricular lymph node were not common. As treatments emerge for viral conjunctivitis patients may need to be encouraged to present earlier.

Paediatric nodal marginal zone lymphoma: a clinicopathological study of seven cases

Objective: To investigate the pathological features and clinical manifestation of pediatric nodal marginal zone lymphoma(NMZL). Methods: Histological morphology and immunophenotype of 7 cases of pediatric NMZL were retrospectively reviewed at Beijing Friendship Hospital Affiliated to Medical University between January 2008 to October 2018. Clonal rearrangement analysis was performed. Clinical information including patient follow-up data were analyzed. Results: All 7 patients were male with a median age of 15 years aged from 10 to 26 years. All patients presented with only lymph node enlargement without B symptoms, including cervical lymph node (5 cases), preauricular lymph node (1 case) and retroauricular lymph node (1 case). Histologically, all cases showed irregular large follicles on the edges with widened marginal areas and intervesicular areas, and lesional cells were uniform with progressive transformation of germinal center centers along with a small amount of intrinsic lymphoid tissue. All 7 cases showed diffuse CD20 positivity both follicle and interfollicular region along with 30%-40% positivity in the interfollicular region (pathological region). Markers of other B-cell lymphomas werenot expressed. All 7 cases were positive for immunoglobulin(Ig) gene rearrangement. None of the patients showed no recurrence up on after follow-up for an average of 13 months. Conclusions: Pediatric NMZL is a rare type of lymphoma that has a unique morphology and occurs almost exclusively in male children and young adults and often in head and neck lymph nodes. It has an excellent prognosis. Therefore, awareness of the disease with accurate diagnosis is important.

Checkpoint inhibition immunotherapy for advanced local and systemic conjunctival melanoma: a clinical case series

BackgroundHerein, we describe the use of systemic immunotherapy for both locally advanced and metastatic conjunctival melanoma. Current treatments for advanced conjunctival melanoma typically result in poor local control leading to disfiguring orbital exenteration surgery. Locoregional spread of conjunctival malignant melanoma typically requires pre-auricular and cervical lymph node dissection with post-operative adjuvant radiation therapy. In addition, classic systemic chemotherapy has been unsuccessful in the treatment of metastatic disease.MethodsThis is a retrospectively analyzed clinical case series of 5 patients with biopsy proven conjunctival melanoma who were treated with checkpoint inhibition therapy. Of these, 3 patients were treated for residual ocular disease present after failing multiple local therapies and refusing orbital exenteration surgery and two (with local ocular control) for metastatic conjunctival melanoma. Both those with locally advanced disease and patients with metastatic disease received an anti-PD1 agent in combination with another immunotherapeutic agent. All 5 were given multiple cycles of systemic anti-PD1 therapy, 1 was initially treated with single agent ipilimumab (3 mg/kg) prior to approval of anti-PD1 agents and two received interferon eye drops. As part of each ophthalmic examination, photographs of all conjunctival and eyelid surfaces were obtained. Systemic evaluations involved initial staging scans as well as periodic re-imaging.ResultsAll cases have shown responses. Of the 2 complete responses, 1 was a patient with systemic disease. No patients developed ocular toxicity or loss of vision. However, systemic adverse effects included adrenal insufficiency, Grade-III colitis, Grade-II dermatitis, Grade-II hepatotoxicity and Grade-II pneumonitis.ConclusionsThis report suggests that systemic immunotherapy with or without topical interferon is effective in treatment of malignant melanoma of the conjunctiva. Therefore, it can be considered for patients with advanced local conjunctival melanoma, those who refuse orbital exenteration surgery and those with systemic metastasis.

Felinosis: the elusive-cat scratch disease

<p class="abstract">Cat-scratch disease or felinosis is an infection caused by <em>Bartonella henselae</em> which is characterized by chronic inflammation of the lymph nodes. It is one of the causes of regional, unilateral adenitis in children and adolescents. Axillary lymph nodes followed by cervical, pre-auricular and submandibular lymph nodes are the most common sites of involvement. We report a 14 year old male patient with cat scratch disease in whom the initial clinical manifestations were indistinguishable from those of acute bacterial suppurative lymphadenitis.</p>

Management of Parotid Metastatic Cutaneous Squamous Cell Carcinoma: Regional Recurrence Rates and Survival.

Objectives Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyzing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting A tertiary referral cancer center in Australia. Subjects and Methods The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or without neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results Of 78 patients, 65 underwent superficial parotidectomy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissections. Involved preauricular, facial, external jugular, and occipital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival-50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)-and improved 2-year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion This study supports surgery plus adjuvant radiotherapy as a standard of care for metastatic cSCC. The low incidence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required.

Primary Conjunctival Tuberculosis.

A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.

Eyelid sebaceous gland carcinoma: Varied presentations and reconstruction outcome.

PURPOSE:To analyze varying clinical presentations, histopathological features, and management outcome of sebaceous gland carcinoma (SGC) of the eyelid.MATERIALS AND METHODS:We retrospectively reviewed medical records of 30 patients with histologically proven cases of SGC of eyelid treated at tertiary care hospital.RESULTS:Patients were in the age group of 28–80 years, among which 18 (60%) were females and 12 (40%) were males. Mean follow-up period was 29.83 ± 8.14 months. Six out of 30 cases were lost to follow-up; hence, only 24 cases were analyzed for reconstruction techniques and management outcome. Initial anatomic sites involved were upper eyelid (10 cases [33.33%]), lower eyelid (5 cases [16.66%]), both upper and lower eyelid (10 cases [33.33%]), and medial canthus (1 case [3.33%]). Orbital extension at presentation was present in 4 cases (13.33%) while metastasis to preauricular lymph nodes was seen in 1 case (3.33%). T2 was the most common category according to TNM staging (14, 58.33%). Reconstruction techniques included direct closure with or without cantholysis in 5 (20.83%), closure with Tenzel's semicircular flap in 2 (8.33%), Cutler Beard repair in 5 (20.83%), and Hughes's flap with either cheek advancement flap or full-thickness skin graft in 3 (12.5%). Both upper eyelid and lower eyelid repair were done in three (12.5%) cases and medial canthal repair in one (4.16%) case. Five (20.83%) cases underwent exenteration. On histopathological examination, 23 (95.83%) patients had localized tumors while only 1 (4.16%) patient had pagetoid invasion. Recurrence was observed in three (12.5%) cases. One (4.16%) case died subsequent to brain metastasis.CONCLUSION:SGC of eyelid may have varied presentations, but early diagnosis and consequent surgical therapy has good outcome and higher survival rate.

Paediatric recurrent preauricular sinus complicated by preauricular lymph node and abscess

Paediatric recurrent preauricular sinus complicated by preauricular lymph node and abscess

The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema.

There are minimal data in the literature regarding the lymphatic drainage of the conjunctiva and lower eyelid and the relationship with postoperative chemosis and edema. Injection, microdissection, and histologic and radiologic studies were conducted on 12 hemifacial fresh cadaver specimens. Indocyanine green lymphography was conducted in five volunteers. Histology identified lymphatic vessels superficial and deep to the orbicularis oculi. Cadaveric dissection, injection, and radiographic studies identified interconnecting superficial and deep facial lymphatic systems and a conjunctival lymphatic network draining through the tarsal plate to the deep lymphatic system. The superficial lymphatic collectors traveled in subcutaneous fat within the lateral orbital and nasolabial fat compartments. The lateral deep lymphatic collectors traveled beneath orbicularis oculi, then through the superficial orbicularis retaining ligament, and into the sub-orbicularis oculi fat in the roof of the prezygomatic space. These vessels descended to preperiosteal fat at the level of zygomaticocutaneous ligaments to travel adjacent to the facial nerve into preauricular nodes. Indocyanine green lymphography identified correlating draining pathways laterally to the parotid nodes and medially to submandibular nodes. The authors have found that the lower eyelid and conjunctiva are drained by interconnecting superficial and deep lymphatic systems of the face. The superficial system is vulnerable to damage in incisions and dissection in the infraorbital area. The deep system is vulnerable to damage in dissection around the orbicularis retaining ligament and the zygomaticocutaneous ligaments. The authors suggest that concurrent damage to both the superficial and deep lymphatic systems, especially laterally, may be responsible for postoperative chemosis and edema.

Clinical, Biological Characteristics and Outcome of Pediatric Follicular Lymphoma at Children's Cancer Hospital - Egypt: A Single Center Experience

Background: Pediatric follicular lymphoma is a rare entity that had been provisionally included in the WHO classification of hematologic malignancies. Unlike adults, pediatric follicular lymphoma patients usually presents with localized nodal disease, are translocation (14; 18) and BCL2 negative. It shows different clinical behavior and thus distinct outcome. We analyzed the three pediatric follicular lymphoma cases presented to Children's Cancer Hospital- Egypt (CCH-E) during the period from July 2007 to December 2014.Results: All patients presented with localized stage II disease, responded well to R-CHOP chemotherapy (Rituximab target therapy with conventional CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). One of them received involved field radiotherapy in addition. All patients are in continuous complete remission. The first case: A male patient 7 years old who presented with left upper deep cervical lymph node with B symptoms (fever and night sweets). Biopsy was taken, partial effacement of the nodal structure and obliteration of the sub-capsular sinus by confluent follicles, intermediate and large cells were seen microscopically. Immunohistochemical staining showed positivity to CD20 and BCL6 and negative reaction to CD3 and BCL2. MIB-1 index was high (80%). The diagnosis of diffuse large cell B-cell lymphoma in 40% of cells and pediatric follicular lymphoma grade 3a in the remaining 60% was made. The patient received 8 cycles of R-CHOP and placed under follow up from July 2011 till now.He is in complete remission. The second case: A male patient 8 years old who presented in March 2013 with recurrent right pre-auricular lymph node. Repeated biopsies were done, all revealed atypical lymphoid hyperplasia. The patient was placed under follow up till April 2014 when he presented with large right parotid mass from which another biopsy was taken. Microscopic examination revealed effaced nodal architecture by evenly distributed large uniform, crowded follicles & nodules, populated by centroblasts intermixed with centrocytes consistent with grade 3a follicular lymphoma. Some foci displayed diffuse pattern with evident extra nodal extension. Immunohstochemical staining showed positive reaction to CD20 and BCL6 while negative reaction to BCL2 and low expression of Ki-67. The diagnosis of pediatric follicular NHL, predominantly grade 3a was made. He received 6 cycles of R-CHOP, evaluation post 3rd cycle was in complete remission by CT and PET scan He completed 6 courses of R-CHOP followed by involved field radiotherapy. He is under follow up since April 2015 till now ; alive and in complete remission. The third case is also for a male patient 12 years old who presented with left parotid and bilateral cervical lymph node enlargement. Initial PET-CT was negative. Cervical lymph node biopsy showed partial effacement of lymph node architecture with observed vague follicular pattern as well as diffuse infiltrate dominantly composed of centroblastic neoplastic lymphoid cells admixed with centrocytes . Immunohostochemical staining revealed positive reaction to CD20 in the neoplastic large cells. BCL2 highlighted mainly the neoplastic cells mainly of diffuse pattern. BCL6 and CD10 highlighted the deformity of neoplastic follicles by growth of neoplastic cells. CD21 stained admixed follicular dendritic cells. Ki-67 labeling index was high (60%). The diagnosis of follicular NHL, mixed follicular and diffuse, grade 3 a was made. He received 6 cycles of R-CHOP, was in complete remission post the third cycle by CT evaluation and is currently under follow up since March 2015.In conclusion, pediatric follicular lymphoma patients presented to our center had localized disease, responded well to R-CHOP chemotherapy and had durable complete remission. DisclosuresNo relevant conflicts of interest to declare.

Tubercular parotitis; a forgotten entity

Tubercular parotitis is extremely rare, even in countries such as India, where the burden of tuberculosis is very high. Clinically, it presents as a slow-growing localized mass, indistinguishable from a neoplasm. Imaging studies are non-specific. USG guided fine needle aspiration cytology (FNAC) can provide a pre operative screening procedure. We present a case of parotid tuberculosis in a 56-year-old diabetic male with short duration of fever and parotitis. We diagnosed the case on the basis of high erythrocyte sedimentation rate, lymphocyte predominant parotitis, epithelioid granuloma in right pre auricular lymphnode and parotid aspirate polymerase chain reaction (PCR) yielding mycobacterium tuberculosis. The patient responded well to 6 months of anti tubercular therapy with optimized diabetes and hypertension management and doing well at the end of 1 year of completion of treatment.