Regional Lymph Node Enlargement Research Articles

Computed tomography features in prediction of histological differentiation of pancreatic neuroendocrine neoplasms - a single-centre retrospective cohort study.

The aim of our study was to analyse the histological differentiation and computed tomography imaging features of pancreatic neuroendocrine neoplasms (PNENs). We performed a retrospective single-centre cohort study of 157 patients with histologically confirmed PNEN. We compared the results of the preoperative biopsy from the tumour with reports of the multi-slice computed tomography performed by a radiologist with 30 years of clinical practice. Specific computed tomography (CT) features are associated with histological differentiation, such as enhancement in the arterial phase (p = 0.032), Wirsung's duct dilatation (p = 0.001), other organ infiltration (p < 0.001), distant metastases (p < 0.001), and enlarged regional lymph nodes (p = 0.018). When there is an organ infiltration, the likelihood of the tumour having histological malignancy grades G2 or G3 triples (95% CI: 1.21-8.06). Likewise, the existence of distant metastases increases the risk almost fourfold (95% CI: 1.44-10.61), and a tumour size of 2 cm or larger is linked to a nearly threefold rise in the risk of histological malignancy grades G2 or G3 (95% CI: 1.21-6.24). Certain CT characteristics: enhancement during the arterial phase, Wirsung's duct dilatation, organ infiltration, distant metastases, and the enlargement of regional lymph nodes are linked to histological differentiation.

Dermatology Photo Quiz 2

40-year-old male, married, and sexually active gentleman, had un-protected sex with other woman, after 5 days, he noticed painful ulcers on his penis. He came to hospital, examination revealed, painful ulcers on glans penis and inner layer of prepuce, with regional lymph node enlargement. Routine and specific investigations were done. Treatment was given, after 10 days, ulcers healed. Genital hygiene and counselling were done, and asked the gentleman to come for regular check-up. Keywords: STD, Chancroid, H ducreyi

Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors.

Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors (NETs) (≤ 10 mm). Moreover, endoscopic mucosal resection (EMR) with double band ligation (EMR-dB), a simplified modification of EMR with band ligation, is an alternative strategy to remove small rectal NETs. To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs (≤ 10 mm). A total of 50 patients with small rectal NETs, without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound, computerized tomography scan, or magnetic resonance imaging, were enrolled in the study from March 2021 to June 2022. These patients were randomly assigned into the EMR-dB (n = 25) group or endoscopic submucosal dissection (ESD) group (n = 25). The characteristics of the patients and tumors, procedure time, devices cost, complete resection rate, complications, and recurrence outcomes were analyzed. There were 25 patients (13 males, 12 females; age range 28-68 years old) in the EMR-dB group, and the ESD group contained 25 patients (15 males, 10 females; age range 25-70 years old). Both groups had similar lesion sizes (EMR-dB 4.53 ± 1.02 mm, ESD 5.140 ± 1.74 mm; P = 0.141) and resected lesion sizes(1.32 ± 0.52 cm vs 1.58 ± 0.84 cm; P = 0.269). Furthermore, the histological complete resection and en bloc resection rates were achieved in all patients (100% for each). In addition, there was no significant difference in the complication rate between the two groups. However, the procedure time was significantly shorter and the devices cost was significantly lower in the EMR-dB group. Besides, there was no recurrence in both groups during the follow-up period. The procedure time of EMR-dB was shorter compared with ESD, and both approaches showed a similar curative effect. Taken together, EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Emerging tick-borne spotted fever group rickettsioses in the Balkans.

The impact of tick-borne pathogens (TBPs) on human health has increased in the last decades, since the incidence of emerging and re-emerging infectious and zoonotic tick-borne diseases has increased worldwide. Tick-borne rickettsiae of the Spotted Fever group (SFGR) are considered as emerging pathogens that can infect humans and cause a variety of non-specific clinical symptoms. Here, we report nine cases of atypical tick-borne diseases (9/460; 1.95%) that occurred over a period of four months (from 15 April 2021 to 16 August 2021) in Serbia, from which five cases were classified as confirmed SFGR infection, two cases as probable SFGR infection and two cases as suspected SFGR infection. Within cases of confirmed SFGR infection, R. helvetica was detected as the causative agent in two cases. The most common clinical finding was non-expanding persistent circular redness, followed by eschar and enlargement of regional lymph nodes, and pain at lesion site. Rickettsia outer membrane protein B (ompB) and citrate synthase (gltA) gene fragments were amplified from clinical samples and ticks attached to patients and IgG reacting with Rickettsia conorii antigen were detected in sera samples of patients, which are highly suggestive of exposure to SFGR. Surveillance and monitoring of rickettsial diseases in Serbia should continue and extended to new areas due to the increasing trend of clinical infections caused by SFGR in the country.

Epidemiological and clinical features of hump-nosed pit viper (Hypnale hypnale and Hypnale zara) envenoming in children.

Bites by the hump-nosed pit vipers (HNPV) of the genus Hypnale are the commonest type of venomous snakebites in Sri Lanka. Their bites frequently cause local effects while rarely causing systemic envenoming, that may include acute kidney injury and coagulopathy. There are 3 species of genus Hypnale including H. hypnale, H. zara and H. nepa from which latter two are endemic to Sri Lanka. Virtually all studies on HNPV bites in Sri Lanka are focused on adults except two studies in paediatric group. The aims of this study were to describe the epidemiology and clinical manifestations of HNPV bites in a group of children admitted to a tertiary care hospital in Sri Lanka. This was a prospective observational study carried out in Teaching Hospital Ratnapura, Sri Lanka over 27 months commencing from May 2020 including all children aged up to 14 years with the history of HNPV bites. There were 40 (56%) HNPV bites, of them 28 (70%) were males. The age was 84 months (50.2-120 months). Majority (n = 21;52.5%) were bitten during day-time (06:00-17:59) in home gardens (n = 20; 50%) on lower limbs (n = 24;60%). Most children (n = 30;75%) were admitted to the medical facility < 4 hours after the snakebite [90 min (40-210 min)] and the hospital stay was 4 days (3-5 days). Local envenoming was observed in 38 patients (95%) and systemic effects developed in 4 patients (10%) as mild coagulopathy. Local effects include local pain (n = 30; 94%), swelling (n = 38;95%), blistering (n = 11;27.5%), necrosis at the site of bite (n = 11; 27.5%), regional lymph node enlargement (n = 8;20%) and local bleeding (n = 4;10%). For the local effects, surgical interventions were needed in 10 children (25%) and 3 (7.5%) of them developed acute compartment syndrome leading to fasciotomy. Leucocytosis (n = 28;78%) and eosinophilia (n = 9;27%) were the prominent laboratory findings. All got recovered except in patients with fasciotomy who got permanent scar. Hump-nosed pit viper bites mostly cause local effects and rarely systemic envenoming in children. Compartment syndrome is common in children following their bites.

Pancreatoduodectomy for solid pseudopaillary neoplasm presenting as a large pancreatic head cyst

Solid pseudopapillary neoplasia of the pancreas is an extremely rare epithelial tumor of low malignant potential that primarily affects young female. We report a case of 19-year-old female with huge pancreatic head cyst presented with mild jaundice, and right upper quadrant pain. CT scan suggested a 13 cm diameter, multi-cystic mass with solid component and enlargement of regional lymph nodes. Preoperatively we diagnoses this patient with huge pancreatic head cyst with malignant potential. Due to the inavailability of ERCP, EUS and FNA, we proceed with surgical resection. She underwent pancreaticoduodenectomy, with post-surgical biopsy confirmed a solid pseudopapillary neoplasia, localized to the pancreas. The post-operative course went uneventfully, and was discharged on post-operative day 10. No adjuvant therapy was given to this patient, and she remained asymptomatic and showed no signs of disease after four months follow-up. It is important to differentiate a solid pseudopapillary neoplasia tumor from other pancreatic cystic neoplasms, because this type is amenable to cure after complete surgical resection, even in cases with capsular invasion, unlike malignant tumors of the pancreas.

Differentiation of Adenomyoma from Localized Adenocarcinoma of the Ampulla of Vater Using Multidetector CT.

PurposeTo determine the multidetector CT (MDCT) findings that differentiate adenomyoma of the ampulla of Vater (AOV) from localized adenocarcinoma of the AOV.Materials and MethodsSixteen and 30 patients with adenomyoma and localized adenocarcinoma of the AOV, respectively, were evaluated using MDCT. We analyzed the size and attenuation value and presence of uniform enhancement of the lesions, diameters of the extrahepatic bile duct (EHD) and main pancreatic duct, presence of regional lymph node enlargement, and laboratory findings. We determined the independent findings for differentiating adenomyoma from localized adenocarcinoma of the AOV using multivariate analysis.ResultsThe size of the lesion and diameter of the EHD were significantly smaller for adenomyoma than those for localized adenocarcinoma of the AOV (all p < 0.001). In multivariate analyses, a lesion size of ≤ 1.3 cm, an EHD diameter of ≤ 1.3 cm, and an alanine transaminase level of ≤ 31 IU/L significantly differentiated adenomyoma from localized adenocarcinoma of the AOV. When all of these three findings were met, the specificity for adenomyoma of the AOV was 93.3%.ConclusionMDCT imaging may facilitate the differential diagnosis of adenomyoma and localized adenocarcinoma of the AOV based on the size of the lesion and diameter of the EHD.

Diagnosis of cervico facial lymphadenopathy by color doppler ultrasound

Aim: The aim of the research is to establish diagnosis of diseases in cervico facial lymphadenopathy by colour Doppler ultrasound. The purpose of the present study is to study the clinical aspects of lymph node and the changes in node in colour doppler ultrasonography. Materials and Methods: Patients were clinically examined by bimanual palpation for cervico facial lymphadenopathy and their colour doppler ultrasound findings were recorded. Biopsy was done to confirm ultrasound findings. Results: The internal architecture of the node, the pattern of colour doppler flow, vascular resistance were assessed in various inflammatory and malignant lymph nodes. Conclusion: The utility of colour doppler ultrasound is really beneficial in establishing the regional lymph node enlargement as inflammatory and metastatic node. Keywords: Lymphnode, Colour doppler, Ultrasound, Reactive nodes, Necrosis, Blood flow.

Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report

BackgroundThe stomach has many incoming vessels and is resistant to ischemia due to the rich microvascular network within its submucosal layer. Although reports of gastric remnant necrosis after gastrectomy have been rare, mortality rates remain substantially high when present. A double elementary diet (W-ED) tube, which can be used for both enteral feeding and gastrointestinal tract decompression, has been developed for anastomotic leakage and postoperative nutritional management after upper gastrointestinal surgery. The current report presents a case of gastric remnant necrosis after proximal gastrectomy that was successfully managed through conservative treatment with a W-ED tube.Case presentationA 73-year-old male was referred to our hospital for an additional resection after endoscopic submucosal dissection (ESD) for gastric cancer. Endoscopic findings showed an ESD scar on the posterior wall of the upper portion of the stomach, while computed tomography (CT) showed no obvious regional lymph node enlargement and distant metastases. The patient subsequently underwent laparoscopic proximal gastrectomy and esophagogastrostomy but developed candidemia on postoperative day 7. On postoperative day 14, endoscopy revealed gastric ischemic changes around the anastomotic site, suggesting that the patient’s candidemia developed due to gastric necrosis. His vital signs remained normal, while the gastric remnant ischemia was localized. Given that surgery in the presence of candidemia was considered extremely risky, conservative treatment was elected. A W-ED tube was placed nasally, after which enteral feeding was initiated along with gastrointestinal tract decompression. Although the patient subsequently developed anastomotic leakage due to gastric remnant necrosis, local control was achieved and conservative treatment was continued. On postoperative day 52, healing of the gastric remnant necrosis and anastomotic leakage was confirmed, after which the patient started drinking water. Although balloon dilation was required due to anastomotic stenosis, the patient was able to resume oral intake and was discharged on postoperative day 88.ConclusionsHerein, we present our experience with a case of gastric remnant necrosis after proximal gastrectomy, wherein conservative management was achieved using a W-ED tube. In cases involving high operative risk, the management should be mindful of gastric remnant necrosis as a post-gastrectomy complication.

Impact of local control and surgical lymph node evaluation in localized paratesticular rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee.

Paratesticular rhabdomyosarcoma (PT-RMS) carries a favorable prognosis, but questions persist regarding optimal management. Our goal was to determine the importance of primary tumor resection and surgical assessment of retroperitoneal lymph nodes during staging in patients with PT-RMS. We analyzed patients with localized PT-RMS enrolled onto one of four Children's Oncology Group studies (D9602, ARST0331, D9803 or ARST0531). Surgical resection of the primary tumor prior to chemotherapy and radiotherapy was encouraged when possible with retroperitoneal lymph node dissection (RPLND) recommended for patients ≥10 years of age. Among 279 patients (median 8.1 years old), most tumors were resected with negative margins (78.5%) and most patients did not have radiographic enlargement of regional lymph nodes (90.3%). In patients older than 10 years, imaging alone will miss over 51.5% of nodal disease. Five-year event-free survival (EFS) was 92.0% (95% CI 88.4%-95.6%). Sampling ≥7 to 12 retroperitoneal lymph nodes appeared optimal for detecting positive nodes; while there was a trend toward improved EFS among those undergoing template RPLND, this was not statistically significant (P = .068). Age (P = .28), N-stage (P = .39), T-stage (P = .11) and pathologic node involvement (P = .53) were not associated with overall survival. However, older age and larger tumor size had an additive impact on EFS (P = .027) though not overall survival (P = .13). In conclusion, outcomes for patients with PT-RMS are excellent. Reliance on imaging to detect nodal involvement will miss pathologic node involvement and may result in undertreatment. Surgical nodal staging requires at least 7 to 12 nodes to accurately identify patients with regional nodal disease.

Caprine nodular thelitis due to Mycobacterium uberis: A series of 26 cases in 11 dairy goat farms in Western France

Bovine Nodular Thelitis (BNT) is a granulomatous dermatitis of teat skin associated with acid-fast bacilli. A similar condition has been recorded in a dairy goat flock in France recently. The causative agent was shown to be related to the leprosy-causing bacilli Mycobacterium leprae and M. lepromatosis, then sequenced and named M. uberis. Following the initial report in goats, the aim of this study was to investigate new cases of Caprine Nodular Thelitis (CNT) in the same area to confirm the presence of M. uberis by molecular techniques and to get a better description of the clinical signs and of the affected flocks. Twenty-six animals (25 females and 1 male) from 11 flocks were included in the study. Lesions were located on the udder/teat skin (24/25), on the body skin (6/25) or on the scrotum skin (1/1). Udder skin lesions were circular, nodular and/or ulcerate covered with a crust and associated with supramammary lymph node enlargement. Body skin lesions were located at different parts of the body, showed large necrotizing ulcers with undetermined edges and were associated with regional lymph node enlargement. Histopathological results indicated granulomatous dermatitis and lymphadenitis of varying intensity with no acid-fast bacilli seen after Fite-Faraco staining. M. uberis DNA was amplified from 26 samples out of 47 (udder: 11/22; lymph node: 11/20; body: 4/5). The female goats were mostly older than 4 year of age and originated from breeding units characterized by large flock size and high proportion of goat in continuous lactation.

Suspected Regional Lymph Node Metastasis in Hepatic Alveolar Echinococcosis: A Case Report

There is no direct evidence to support the existence of regional lymph node metastatic routes in hepatic alveolar echinococcosis, and only a few literature have been reported. There was a case of hepatic alveolar echinococcosis suspected of metastasis of regional lymph node in Clinical Center for Hydatidosis, Qinghai Province, China. The patient was a 24-yr-old male from pastoral area of Seda County, Sichuan Province, China in 2018. He was admitted to the hospital for physical examination and had no special discomfort. Preoperative examination showed liver occupancy and regional lymph node enlargement in the space between liver and stomach. Hepatectomy and lymph node resections were performed. Postoperative pathological results showed that both primary and metastatic lesion were of alveolar echinococcosis. Recovery of patient was good without complications and recurrence. In this case, metastasis was considered because the liver lesion was not directly connected to the lymph node. However, the case was still suspected due to the lack of pathological examination of other lymph nodes in the lymphatic return pathway. Regional lymph node metastasis may be one of the metastatic ways of alveolar echinococcosis.

Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD

sBackgroundLymph node (LN) metastasis is negligible in early gastric cancer (EGC) within expanded criteria for endoscopic submucosal dissection (ESD). However, regional lymph nodes in abdominal CT scans are sometimes enlarged in patients with EGC within the expanded criteria for endoscopic submucosal dissection (ESD). In this study, we investigated the clinical significance of regional lymph node enlargement on abdominal CT scan in patients with EGC within the expanded criteria for ESD.MethodsFrom December 2010 to April 2015, among 301 patients with EGC within the ESD expanded criteria, 47 patients with regional lymph node enlargement shown by abdominal CT scan were prospectively enrolled. We performed surgical resection or periodic follow-up with abdominal CT scans and upper endoscopy every 6 months to evaluate whether the enlarged lymph nodes are due to metastasis or a reactive change.ResultsThe mean age of the 47 patients (38 males, 9 female) was 64.8 years. The enlarged lymph nodes were usually single (26/47, 44.6%) and sized as follows: 11 nodes were ≤ 5 mm, 19 were 6–10 mm, and 17 were ≥ 10 mm. Four of the 47 patients initially underwent surgical resection, and 8 patients underwent surgical resection after ESD. However, there was no lymph node metastasis in surgical specimens. Thirty-five patients received ESD and periodically followed up at a median duration of 56 months (IQR: 44–59 month). The enlarged lymph node disappeared in 12 of 35 patients, decreased in 9 patients and remained the same size in 13 patients, and increased in 1 patient.ConclusionRegional lymph node enlargement on abdominal CT scan in patients within expanded criteria for ESD of ECG may be not due to metastasis but a reactive change.

The Difference in the Clinical Features Between Carcinoma ex Pleomorphic Adenoma and Pleomorphic Adenoma.

Carcinoma ex pleomorphic adenoma (CXPA) arises from the primary or recurrent benign pleomorphic adenoma. The purpose of this study was to evaluate the clinical features that could be referenced in the differentiation. The medical records of 221 patients with pleomorphic adenoma and 15 patients with CXPA were retrospectively reviewed. Clinical characteristics, computed tomography and magnetic resonance imaging findings, and surgical pathology were analyzed. Patients with CXPA were older (55.1 vs 42.3; P < .01). Carcinoma ex pleomorphic adenoma was observed at higher rates in the minor salivary glands (24.9% vs 2.7%) and higher incidence of regional lymph node enlargement (P = .04). While all CXPA showed a low-to-intermediate mean apparent diffusion coefficient value (ADC), most of pleomorphic adenoma had an intermediate-to-high (P = .01). From this study, the following features should be considered as the clinical features of CXPA: (1) old age; (2) minor salivary gland tumor; (3) regional lymph node enlargement (>5 mm); and (4) low ADC findings.

Pancreatoduodectomy for solid pseudopaillary neoplasm presenting as a large pancreatic head cyst

Introduction Solid pseudopapillary neoplasia of the pancreas is an extremely rare epithelial tumor of low malignant potential that primarily affects young female. Methods We report a case of 19-year-old female with huge pancreatic head cyst presented with mild jaundice, and right upper quadrant pain. CT scan suggested a 13 cm diameter, multi-cystic mass with solid component and enlargement of regional lymph nodes. Results Preoperatively we diagnoses this patient with huge pancreatic head cyst with malignant potential. Due to the inavailability of ERCP, EUS and FNA, we proceed with surgical resection. She underwent pancreaticoduodenectomy, with post-surgical biopsy confirmed a solid pseudopapillary neoplasia, localized to the pancreas. The post-operative course went uneventfully, and was discharged on post-operative day 10. No adjuvant therapy was given to this patient, and she remained asymptomatic and showed no signs of disease after four months follow-up. Conclusions It is important to differentiate a solid pseudopapillary neoplasia tumor from other pancreatic cystic neoplasms, because this type is amenable to cure after complete surgical resection, even in cases with capsular invasion, unlike malignant tumors of the pancreas.

A case series of Kimura’s disease: a diagnostic challenge

Kimura's disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20-30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin's disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin's disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed-Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.

Gray scale and doppler ultrasonography features of the carcinoma ex pleomorphic adenoma.

For lesions in the salivary glands, ultrasonography (US) is an ideal tool for initial assessment. The aim of this study was to characterize and differentiate between the Gray scale and Doppler US findings of intracapsular carcinoma ex pleomorphic adenoma (Ic-CxPA) and invasive carcinoma ex pleomorphic adenoma (Inv-CxPA). A total of 87 patients (89 lesions) with histopathologically proven CxPA underwent US examination. The following characteristics were assessed on US images: size, shape, border, echogenicity, echo texture, posterior echo, vascularity, and regional lymph node enlargement. One-way analysis of variance (ANOVA), nonparametric test, Fisher's exact test, chi-square test and receiver operating characteristic (ROC) curve were used for the analyses of the US findings of Ic-CxPAs and Inv-CxPAs. We found that on US images, nearly all Ic-CxPAs (10/11) and a few of Inv-CxPAs (17/78) showed benign features, such as a regular shape, a well-defined border, and enhancement of posterior echo, while most Inv-CxPAs (61/78) showed one or more following features: an irregular shape, an ill-defined border, and lack of enhancement of posterior echo. Ic-CxPAs tended to exhibit benign features, whereas most Inv-CxPAs tended to exhibit one or more invasive features. US can provide strong evidence in differentiating Inv-CxPAs from Ic-CxPAs.

Bacille Calmette–Guerin lymphadenitis in infants: A lesser known entity – Report of two cases

Bacille Calmette–Guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis (TB) in 1921. Intradermal BCG vaccine gives rise to classic primary complex that consists of a cutaneous nodule at the site of injection and subclinical involvement of the regional lymph nodes, which is self-limiting and requires no treatment. BCG lymphadenitis is the most common complication of BCG vaccination. Fine-needle aspiration is the rapid, safe, and cost-effective method for diagnosis as well as the management of BCG lymphadenitis. Awareness of this lesser known entity is important to prevent misdiagnosis. We report two cases of 2½ month and 6-month healthy male infants with left axillary lymphadenopathy following BCG vaccination. Fine-needle aspiration from both the cases revealed features of necrotizing granulomatous lymphadenitis with Ziehl-Neelsen stain for acid-fast bacilli being positive in 2nd case. Ipsilateral regional lymph node enlargement following BCG vaccination is considered as the most common complication, some progress to suppuration. Very rarely disseminated BCG infection may develop in immune-compromised individuals, resulting in a devastating outcome. Variable strategies have been applied in treating lymphadenitis related to BCG vaccine in the past decade, ranging from observation, antimycobacterial therapy, aspiration, incision, and drainage to lymph node surgical excision.

A Granular Cell Tumor of the Rectum: A Case Report and Review of the Literature.

A granular cell tumor (GCT) is an uncommon mesenchymal lesion that rarely occurs in the colon and the rectum. We describe the case of 51-year-old man with a 2-cm-sized rectal GCT 10 cm above the anal verge that was incidentally detected after a screening colonoscopy. Preoperative radiologic studies demonstrated a suspicious submucosal rectal mass with mesorectal fat infiltration, but without circumferential resection margin threatening, extramural vessel invasion, and regional lymph-node enlargement. The tumor was resected by using a transanal endoscopic operation (TEO) without immediate postoperative complications. The final pathology revealed that the tumor consisted of a GCT that had invaded the subserosa with clear margins. It had no other risk factors for malignancy according to Fanburg-Smith criteria. We systematically reviewed the English literature by using PubMed and Google Scholar. This report may be the first documented case in the literature to describe a TEO for a GCT that had invaded the subserosa in the rectum.

Human myiasis caused by the reindeer warble fly, Hypoderma tarandi, case series from Norway, 2011 to 2016.

Hypoderma tarandi causes myiasis in reindeer and caribou (Rangifer tarandus spp.) in most northern hemisphere regions where these animals live. We report a series of 39 human myiasis cases caused by H. tarandi in Norway from 2011 to 2016. Thirty-two were residents of Finnmark, the northernmost county of Norway, one a visitor to Finnmark, and six lived in other counties of Norway where reindeer live. Clinical manifestations involved migratory dermal swellings of the face and head, enlargement of regional lymph nodes, and periorbital oedema, with or without eosinophilia. Most cases of human myiasis are seen in tropical and subtropical countries, and in tourists returning from such areas. Our findings demonstrate that myiasis caused by H. tarandi is more common than previously thought. Healthcare professionals in regions where there is a likelihood of human infestation with H. tarandi (regions populated by reindeer), or treating returning travellers, should be aware of the condition. All clinicians are advised to obtain a detailed travel history when assessing patients with migratory dermal swellings. On clinical suspicion, ivermectin should be given to prevent larval invasion of the eye (ophthalmomyiasis). Since H. tarandi oviposits on hair, we suggest wearing a hat as a prevention measure.