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Lymphadenopathy in an immunosuppressed patient raises the quintessential diagnostic dilemma: infection or malignancy? We present the case of a transplant recipient on anti-rejection prophylaxis admitted with acute fever, malaise and a swollen right axillary node. The patient had pancytopenia and tested positive for Epstein–Barr virus; nodal core biopsy demonstrated atypical plasma cell infiltration, immediately raising suspicion for post-transplant lymphoproliferative disorder. However, excisional biopsy and Bartonella henselae serology clarified a final diagnosis of cat-scratch disease—a potentially fatal zoonosis requiring a disparate treatment regimen. Here, we explore this patient's investigations, hospital course and recovery, with an emphasis on recognizing and differentiating these diagnostic mimics in post-transplant practice. [ABSTRACT FROM AUTHOR]

Objective: Excisional lymph node biopsies are usually conducted in a minor procedure room under local anesthesia, and in some cases, they can also be carried out in an operating room under general anesthesia. Our study aims to compare the diagnostic accuracy, pathological results, and necessity for biopsy repetition of excisional lymph node biopsies performed in both the minor procedure room and the operating room. Materials and Methods: This study provides a retrospective analysis encompassing 60 patients who underwent excisional lymph node biopsy procedures. Within the ambit of this investigation, a comparative analysis is conducted on the outcomes of lymph node excision procedures, differentiating those carried out in the minor procedure room from those executed in the operating room. Results: Out of 47 excisional lymph node biopsy samples conducted in the minor procedure room, 45 had a diagnostic feature, while among the 13 excisional lymph node biopsy samples performed in the operating room conditions, 12 had a diagnostic feature. The entirety of samples obtained in the operating room concurred with pathology reports, and 88.9% of the samples taken in the minor procedure room demonstrated congruence between pathology report outcomes and clinical findings. In two cases where a definitive diagnosis could not be established, repeat biopsies were administered; however, alterations in the final biopsy results were observed in only one of these patients. Conclusion: Considering factors like cost and the achievement of similar outcomes in both methods, we believe that conducting excisional lymph node biopsies in the setting of a minor procedure room is a preferable option. [ABSTRACT FROM AUTHOR]

Objectives: Use of fine-needle aspiration/needle core biopsy (FNA/CNB) in evaluating hematolymphoid processes has been debated. We investigate its applicability in various clinicopathologic settings.Methods: We retrospectively analyzed 152 cases of FNA/CNB.Results: Of 152 FNA/CNBs, 124 (81.6%) resulted in diagnoses without excisional biopsies, while 28 required subsequent excisional biopsies. Of these, 43 FNA/CNBs performed for suspected lymphoma relapse demonstrated 95.4% diagnostic rate (41/43), which was significantly better than those without history of lymphoma (77/109, 71%; odds ratio [OR], 8.5; confidence interval, 1.9-37.4). Patients with immunodeficiency also showed a high rate of diagnosis by FNA/CNB (100%). When stratified by types of disease, diffuse large B-cell lymphoma/high-grade B-cell lymphoma demonstrated a higher success rate (92.7%) than small B-cell lymphoma (79.2%), though the difference was not statistically significant (OR, 3.3; P value = .07). A subsequent excisional biopsy was required in 28 cases, 23 of which resulted in diagnoses concordant with the FNA/CNB. Five cases showed diagnostic discordance, reflecting pitfalls of FNA/CNB in unusual cases with complex pathology.Conclusions: FNA/CNB is practical in evaluating most hematolymphoid lesions, with high efficacy in recurrent disease and some primary neoplasms with homogeneous/ aggressive histology, or characteristic immunophenotype. [ABSTRACT FROM AUTHOR]

Purpose: Breast masses in children and adolescents are uncommon and the vast majority are benign. There are currently limited analyses of breast masses in this population and clinical management is highly variable between institutions and providers. The purpose of our study is to analyze the demographics, pathology and management of 119 pediatric patients with breast masses; one of the largest studies to date.Methods: We performed a retrospective review of patients who underwent excision of a breast mass at a single pediatric center from June 2009 to November 2013. Demographics, imaging, pathology and management were reviewed.Results: Average patient age was 15.3 years, average mass size was 3.15 cm and 20.3 % had a family history of breast cancer. 68 % of patients had pre-operative ultrasound, and 31.9 % underwent a period of observation. The most common indication for resection was patient and family anxiety. All masses were benign, with fibroadenoma being the most common histopathology (75.2 %).Conclusions: In our cohort there were no cases of malignancy. Only 31.9 % of patients underwent some form of observation and patient or family anxiety was the most common indication for proceeding with surgery. This suggests that patient anxiety may result in unnecessary operation. Our data may help reassure patients, families and providers that the risk of malignancy is low and could help develop more optimal management strategies. [ABSTRACT FROM AUTHOR]

Background This study was undertaken to show how an excisional biopsy procedure can be used to remove the entire specimen for oral lesions with difficult diagnoses. Methods We retrospectively reviewed 52 cases with 56 oral lesions either suspected to be malignant or with a preliminary controversial diagnosis. These were treated by excisional biopsy with frozen section intraoperatively between January 2003 and June 2008. Results Twenty-eight of 56 lesions were diagnosed with malignancy. We found a high underdiagnosis rate (7 of 12) in patients who had a preliminary controversial diagnosis. Twenty-one patients without preoperative biopsy were diagnosed to have malignancies. Of the 28 malignant cases, all surgical margins were negative. Neck ultrasound scans with fine-needle aspiration cytology was carried out and no patient demonstrated simultaneous neck metastasis. One patient died of locoregional recurrence. Two patients died of a second primary cancer. Conclusion Excisional biopsy with margin control is useful both in diagnosis and treatment of oral cancers. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

Congenital epulis (CE) of the newborn is a rare benign soft tissue tumor that presents at birth. It occurs usually as a single mass with various sizes, although some multiple lesions have also been reported. The lesion is more common in female neonates and normally affects the maxillary alveolar ridge. Rare recurrence and no malignant alteration have also been reported. This condition may interfere with respiration, feeding or adequate closure of the mouth. A decisive diagnosis is made by histopathologic analysis as other newborn lesions can be incorrectly diagnosed as CE. This article presents a case report of a female infant who presented a fibrotic mass in the primary lateral incisor and canine region of the maxillary alveolar ridge. The lesion was not causing feeding or respiratory problems. After a watchful waiting procedure and no spontaneous regression, the lesion was excised under local anesthesia and confirmed by histopathologic analysis as CE. [ABSTRACT FROM AUTHOR]

A 72-year-old Taiwanese woman had the history of cosmetic cryopreserved autologous fat injection on her forehead ~21 years ago and was referred to our oculoplastic clinic and presented with multiple painless mass, which she had for 4 years, on both upper eyelids. Histopathology confirmed the diagnosis of foreign body granuloma on both upper eyelids. Clinicians should be aware of the potential complication of granuloma reaction and migration even many years after the injection. We advise that autologous fat injection should be performed solely by trained physicians and it should be made known that there is a possible occurrence of migration. [ABSTRACT FROM AUTHOR]

Summary: Tumours arising from the plantar aspect of the foot are rare, have a delayed presentation and are frequently misdiagnosed. The authors report a series of five cases where in, the cases presented late and were being treated as ulcers or insignificant swellings. This article highlights the need for high degree of suspicion, appropriate investigations and excisional biopsy of all lesions arising in the sole of the foot. [Copyright &y& Elsevier]

Abstract: This contribution initially looks at the anatomy and pathophysiology of the salivary glands. It discusses the cause, incidence and prevalence of neoplasms. Investigations and diagnosis, surgical management, complications of surgery and prognosis are also discussed. [Copyright &y& Elsevier]

Angioleiomyomas are defined as benign dermal or subcutaneous tumours consisting of smooth muscle cells arranged around vascular channels. Head and neck angioleiomyomas are rarely encountered as they usually occur in the extremities. We report a case of a 71-year-old male, who presented with a 3-month history of a painless lateral neck lump. Ultrasound and computed tomography scans localised the suspicious hypervascular tumour to the right supraclavicular fossa between the two heads of sternocleidomastoid muscle. He subsequently underwent an excisional biopsy, where histological analysis determined that the lateral neck mass was a venous subtype angioleiomyoma. To the best of our knowledge, this is only the third reported case of an angioleiomyoma in the supraclavicular fossa. Although supraclavicular masses are typically synonymous with malignancy, this case report highlights that angioleiomyoma should be considered as a differential diagnosis when investigating patients with a lateral neck lump. [ABSTRACT FROM AUTHOR]

We present an uncommon presentation of a common disease in a completely asymptomatic woman. She presented with a solitary breast nodule incidentally found on her first mammography. A step-by-step evaluation of the breast nodule, including fine-needle aspiration and excisional biopsy, was done which revealed mammary gouty tophus. [ABSTRACT FROM AUTHOR]

Highlights from the article: In conclusion, an internal jugular vein aneurysm is a benign Internal jugular vein aneurysm.

Adenoid cystic carcinoma of the breast (ACC) is a rare tumor, comprising <0.1% of all breast cancers. It has a unique dual-cell pattern and is indistinguishable from ACC arising from salivary tissue. It is a low-grade tumor with favorable prognosis, and rare metastasis, with unique features. It is more commonly seen in older women with a mean age at diagnosis of 63, with Caucasian women being at greatest risk. Most cases present as a painful, palpable mass in the outer quadrants of the breast, and must be diagnosed via core needle biopsy or surgical excisional biopsy. Although few other cancers resemble ACC it is commonly misdiagnosed. Given the rarity of this cancer, treatment guidelines have yet to be well established. Current treatment is focused around surgical resection, however, there are not specific recommendations for the extent of resection due to the lack of cases to draw from. [ABSTRACT FROM AUTHOR]

Intracerebral schwannomas are quite rare. Due to their rarity and lack of pathognomonic imaging features, intracerebral schwannoma may be overlooked in the initial differential diagnosis of an intra-axial mass with heterogeneous ring enhancement, such as a high-grade glioma, metastasis or lymphoma. Here, we present a 21-year-old woman with prior diagnosis of papillary thyroid carcinoma and recent history of seizures who had a heterogeneously ring-enhancing left frontal lobe mass. Our presumptive diagnosis was a metastatic tumor since she had a history of thyroid cancer. Because of uncertainty in preoperative differential diagnosis, the decision was made to proceed with excisional biopsy of the tumor via craniotomy. She underwent uneventful gross total resection of the tumor that histopathology revealed as an intracerebral schwannoma. [ABSTRACT FROM AUTHOR]

A palpable breast mass is a common reason for surgical consultation. Our goal was to determine whether ultrasound-guided vacuum-assisted core biopsy (US-VACB) is safe and effective in completely removing presumed benign palpable breast masses. We conducted a cohort study of 201 consecutive patients with presumed benign palpable masses who underwent removal with US-VACB. The main outcome measured was the successful removal of palpable masses. Palpable masses were successfully removed with US-VACB in 99% of cases; 2% were cancer and 7.5% were atypical ductal hyperplasia or phyllodes tumor. Two clinical recurrences representing a seroma were seen on follow-up. US-VACB is safe and effective in the initial diagnosis and management of presumed benign palpable breast masses. It provides the benefits of percutaneous biopsy and the palpable abnormality no longer remains. [ABSTRACT FROM AUTHOR]