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Angiomyomatous hamartoma (AMH) is a rare benign lesion of the lymph nodes. Angiomyomatous hamartoma tends to be found in inguinal lymph nodes, and usually in a single lymph node. We present a rare care case of a 53-year-old presenting with a neck lump, found to be AMH involving multiple lymph nodes in her neck. To our knowledge, this is the first case presenting with multiple nodes in this location. There are a limited number of case reports describing magnetic resonance imaging (MRI) features of AMH lesions located in inguinal and head and neck regions. Our MRI findings revealed the mass had intermediate T1 enhancement, high T2 signal enhancement, and high post-gadolinium enhancement and fat saturation of the lesion. Angiomyomatous hamartoma is a histological diagnosis, distinguished from other similar nodal vascular lesions by a number of key features: including the presence of central nodal distribution, muscular blood vessel walls, adipose tissue, and HMB45 negative staining. Early recognition of this benign lesion may have implications for a patient's clinical course and surgical requirements. [ABSTRACT FROM AUTHOR]

This case report aims to highlight the importance of considering lymphoma as a potential differential diagnosis in patients presenting with laryngeal mass and associated cervical lymphadenopathy, particularly those with a history of chronic tonsillitis. A case of a 63-year-old male patient who underwent bilateral tonsillectomy for tumor in the left tonsil was presented. Two months after the procedure, he developed throat discomfort, dysphagia, neck swelling, and other symptoms. The patient was initially diagnosed with "tongue base mass" and chronic lymphadenitis. Partial excision of the tongue base mass was performed twice in another hospital, revealing chronic inflammation of the epithelial mucosa. Further evaluations, including electron laryngoscopy and imaging studies, were conducted to investigate the condition. A computed tomography (CT) scan showed irregular soft tissue density in the oropharyngeal region, along with multiple lymph nodes in the neck. Subsequent histopathological examination of the lingual base biopsy revealed peripheral T-cell lymphoma with a follicular T-helper cell phenotype. Immunohistochemical staining confirmed specific markers while ruling out other markers. In situ hybridization testing demonstrated positivity for Epstein-Barr virus-encoded RNA, and TCRG clonality was confirmed. The duration from symptom onset to diagnosis was 2 months. This case emphasizes the importance of considering lymphoma in patients with laryngeal mass and associated cervical lymphadenopathy, especially when a history of chronic tonsillitis is present. Accurate diagnosis and early intervention are crucial for effective management and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) affecting the head-and-neck area can often resemble cancer, leading to misdiagnosis and delayed treatment. A better understanding of this condition is necessary for early diagnosis and prompt treatment initiation. This study examines the clinical and pathological characteristics of different types of TB in the head-and-neck region. Methods: This retrospective study analyzed patients diagnosed with TB in the head-and-neck region at a health center between January 1, 2018, and January 1, 2024. The study population consisted of patients who were diagnosed with TB of the head and neck. Results: The study analyzed data from 30 patients, comprising 14 (47%) males and 16 (53%) females, all of whom tested negative for HIV. Most cases (15, 50%) were observed in the age group of 15–24 years, with 5 (15.6%) subjects falling in the age bracket of 0–14 years. Among the types of lesions detected, cervical tubercular adenitis was the most frequently observed lesion, found in 22 (73%) subjects. Females are more susceptible to cervical tubercular adenitis, while males are more likely to experience laryngeal TB. Conclusion: The clinical manifestation of TB affecting the head-and-neck region can exhibit a diverse range of symptoms, which may lead to misinterpretation and diagnostic errors. Therefore, health-care practitioners must understand and include the condition in differential diagnoses.

Pancoast tumors, also known as superior sulcus tumors, encompass a diverse spectrum of neoplasms that infiltrate the apex of the chest wall, yielding distinctive clinical presentations. One of the earliest signs of tumor growth is pain radiating to the upper limb, stemming from peripheral nerve involvement, which can mimic joint pain or spinal radicular irritation. In this case report, we present the clinical history of a 64-year-old female smoker who had previously been recommended for orthopedic elbow surgery due to epicondylitis. Subsequent to the development of additional symptoms and rigorous investigation, a Pancoast tumor was diagnosed. Furthermore, we discuss the characteristic treatment modalities available for Pancoast tumors, including pharmacological pain management and interventional strategies such as spinal cordotomy and spinal alcoholysis. This case underscores the significance of recognizing atypical presentations and emphasizes the importance of comprehensive evaluation in the diagnosis and management of Pancoast tumors.

Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy. Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed. Patients were stratified into initial biopsy, delayed biopsy, or no biopsy groups. Clinical characteristics and workup were compared, and multivariate analyses were performed to assess predictors of delayed biopsy. 568 patients were identified, with 493 patients having no biopsy, 41 patients undergoing initial biopsy, and 34 patients undergoing delayed biopsy. Presenting symptoms differed: no biopsy patients were younger, were more likely to present to the emergency department, and had clinical findings often associated with acute illness. Patients with USs revealing abnormal vascularity or atypical architecture were more likely to be biopsied. History of malignancy, symptoms >1 week but <3 months, and atypical or change in architecture on US was associated with delayed biopsy. Patients with long-term follow-up (LTF) were followed for a median of 99.0 days. Malignancies were identified in 12 patients (2.1%). All malignancies were diagnosed within 14 days of presentation, and no malignancies were identified in LTF. Patients with persistent low suspicion lymphadenopathy are often followed for long durations; however, in this cohort, no malignancies were diagnosed during LTF. We propose an algorithm of forgoing a biopsy and employing primary care surveillance and education, which may be appropriate for these patients in the proper setting. • Cervical lymphadenopathy is often self-limited but may represent a malignancy. • Single institutional review revealed low incidence of malignancy. • All patients with malignancy were identified on biopsy within 2 weeks. • For clinically low-risk patients, the utility of long-term observation is unknown. [ABSTRACT FROM AUTHOR]

Background: The enlargement of Cervical lymph nodes is quite significant in that there are so many etiological agents and is an index spread of infections, malignancy, autoimmune disorders, and some other miscellaneous conditions etc. is very much difficult to diagnosis. So the purpose of our study is to systematically identify the many pathogenic conditions presenting with enlarged lymph nodes in the neck, as well as the scenario of different ways of presentation of these disorders both clinically and pathologically with the help of FNAC and Ultrasonography diagnostic techniques there by better management services could be rendered to the affected individuals in our set up. Research Question: What is the scenario of different ways of presentation of cervical lymphadenopathy both clinically and pathologically in our set up? The setting of the study was at department of General Surgery, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one year observational study was conduct during the period from October 2022 to September 2023 on about 60 Cervical lymphadenopathy cases visited General Surgery OPD during the above period by studying their socio-demographic profiles, histopathological examination of Lymphadenopathy, distribution of presenting complaint, distribution of primary cancerous site with neck secondaries and treatment & outcome of the study subjects etc. Results: It was observed that the majority about 35% of cases were belongs to the age group 41-50 years followed by 23.5% between 21-30 years, 16.6% between both 31-40 years & 51years and above and 8.5% between 12-20 years of age group with the mean age was 58.3 years. And regarding the sex males were more in number significantly when compared to females that was 1.7:1. Regarding histopathological diagnosis and categorisation, majority of the cases were Tuberculosis lymphadenopathy (43.5%) followed by Secondaries (28.3%) Reactive lymphadenopathy (23.3%), Hodgkin's lymphoma (3.3%) and Non-Hodgkin's lymphoma (1.6%). Related to distribution of presenting complaint almost all the cases were visited the hospital with the complaint h/o neck swelling and among the other symptoms fever was the common one (33.3%) followed by cough (30%), decreased appetite (26.6%), weight loss, pain (20%), painful swallowing (3.3%) and voice change (1.6%). With reference to Primary cancerous sites with neck secondaries, Oral cavity occupies major position (23.5%) followed by Larinx (11.7%), Stomach (11.7%), Esophagus (5.8%) and Thyroid (5.8%) respectively and regarding histopathology Squamous cell carcinoma was the commonest one observed. The overall recovery rate was 65% and the complete recovery (100%) was observed among Tubercular cervical lymphadenitis and Reactive lymphadenitis and the maximum number of cases missed for the followup was observed in Secondaries neck and mortality was observed in Secondaries neck and Hodgkin's lymphoma. [ABSTRACT FROM AUTHOR]

Background: Lateral neck swellings in ENT have various causes, commonly found in the anterior triangle of the neck. Accurate diagnosis through imaging, FNAC, and biopsy is crucial for appropriate treatment, ranging from conservative management to surgery. Understanding incidence, etiology, pathology, and clinical behaviour is important for effective management and follow-up. Materials and Methods: Institutional Ethical committee approval was obtained and informed consent was taken from the study subjects. Patients with lateral neck swellings underwent clinical examination and FNAC, followed by further investigations based on FNAC reports. Lymph node biopsies were taken for histopathological examination. Management was based on the final diagnosis, and patients were followed up for six months. Results were analyzed and tabulated. Results: In our study of 96 patients, lateral neck masses were most common in individuals aged 46-59, with an equal male-to-female ratio. The majority of cases (82.29%) were from low socioeconomic status. Metastasis in cervical lymph nodes was the most frequent cause of lateral neck swellings, primarily in males aged over 45, and tubercular lymphadenitis was the second most common cause in females aged 18-30. The clinical diagnosis had high sensitivity (87.18%) and specificity (92.98%) for detecting malignant lesions, and these values increased when the histopathological examination was used as the gold standard. Conclusion: To evaluate and manage lateral neck swellings, a multidisciplinary approach is necessary, including medical history, clinical examination, imaging, and pathological investigations like FNAC and HPE. Prompt and accurate diagnosis is critical to prevent morbidity and mortality, and management depends on the underlying cause. Effective management requires close communication between the clinician and the pathologist. [ABSTRACT FROM AUTHOR]

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Clinicians involved in the diagnosis of mucocutaneous diseases should be aware that syphilis is still prevalent among humans and its accurate diagnosis may require substantial clinical evaluation. Herein, we report a case of primary syphilis presenting as an isolated ulcer on the upper left labial oral mucosa. The lesion exhibited no specific features and could have been easily mishandled. An important clinical observation was the presence of a satellite-enlarged lymph node in the left submandibular area, which was highly indicative of primary syphilis. Histopathological examination of the specimen obtained by punch biopsy revealed features suggestive of syphilis and immunohistochemical staining with antitreponemal antibody confirmed its diagnosis with the detection of numerous Treponema pallidum in the specimen.

Accurate differentiation of benign and malignant cervical lymph nodes is important for prognosis and treatment planning in patients with head and neck squamous cell carcinoma. We evaluated the diagnostic performance of magnetic resonance image (MRI) texture analysis and traditional 18F-deoxyglucose positron emission tomography (FDG-PET) features. This retrospective study included 21 patients with head and neck squamous cell carcinoma. We used texture analysis of MRI and FDG-PET features to evaluate 109 histologically confirmed cervical lymph nodes (41 metastatic, 68 benign). Predictive models were evaluated using area under the curve (AUC). Significant differences were observed between benign and malignant cervical lymph nodes for 36 of 41 texture features (p < 0.05). A combination of 22 MRI texture features discriminated benign and malignant nodal disease with AUC, sensitivity, and specificity of 0.952, 92.7%, and 86.7%, which was comparable to maximum short-axis diameter, lymph node morphology, and maximum standard uptake value (SUVmax). The addition of MRI texture features to traditional FDG-PET features differentiated these groups with the greatest AUC, sensitivity, and specificity (0.989, 97.5%, and 94.1%). The addition of the MRI texture feature to lymph node morphology improved nodal assessment specificity from 70.6% to 88.2% among FDG-PET indeterminate lymph nodes. Texture features are useful for differentiating benign and malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Lymph node morphology and SUVmax remain accurate tools. Specificity is improved by the addition of MRI texture features among FDG-PET indeterminate lymph nodes. This approach is useful for differentiating benign and malignant cervical lymph nodes. [ABSTRACT FROM AUTHOR]

Introduction: Among all palpable and nonpalpable masses, enlargement of lymphnodes is a most common clinical presentation in children.] There is now increasing application of FNAC in palpable and nonpalpable mass in pediatric cases. Advantages of FNAC over surgical biopsy are rapid, cost-effective, low trauma rate, minimal complications, and morbidity. Methodology: A retrospective cross-sectional study was done for all pediatric patients, who came for FNAC in cytology section of pathology department of GMERS Medical College & General Hospital, Junagadh for 4 years duration from January 2019 to December 2022. FNAC slides were retrieved and reviews and findings were recorded. Result: Total 80 cases were studied, among that 23 (28.8%) cases were of chronic nonspecific lymphadenitis, 12 (15%) cases were of reactive lymphadenitis, 10 (12.5%) cases were of chronic granulomatous lymphadenitis, 11 (13.8%) cases were of acute suppurative inflammation, 4 (5%) cases were of abscess, 3 (3.8%) cases were of cystic lesion, 2 (2.5%) cases were of acute inflammation, necrotizing lymphadenitis, chronic sialoadenitis, and pleomorphic adenoma, while 1 (1.3%) case of acute sialoadenitis, myoepithelial adenoma, colloid goiter and 12 (15%) cases was unsatisfactory for diagnosis. Most cases were of lymphadenopathy, which is 67 (83.8%) cases. Conclusion: Most common causes of all palpable and nonpalpable lesion in pediatric patients were chronic nonspecific lymphadenitis (28.8%) followed by reactive lymphadenitis (15%) and chronic granulomatous lymphadenitis (12.5%). Maximum cases among all cases were from cervical (neck) region lesions and between 6-12 years of age group. [ABSTRACT FROM AUTHOR]

Objective: Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy. Study Design: A retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management. Setting: University of California, San Francisco Pediatric Otolaryngology Department. Results: Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p =.04), firmness (p <.001), and lack of a normal fatty hilum on ultrasound (p =.04) as statistically significantly correlated with decisions for surgical management. Conclusion: The majority of pediatric PACL is benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow‐up with neck ultrasound can be used to safely monitor patients. [ABSTRACT FROM AUTHOR]

Background: The microbiological diagnosis of extrapulmonary tuberculosis (TB) is quite difficult because of paucibacillary load and required radiological, cytohistopathological tests for confirmation along with clinical suspicion in case of cervical TB lymph node, body fluid examination such as pleural fluid, cerebrospinal fluid, ascitic fluid in cases of TB pleurisy, TB meningitis, and abdominal Koch’s and was quiet challenging before inclusion of CBNAAT. Aims and Objectives: The aim of the study was to study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Materials and Methods: To study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel, and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Results: In this study, 23 cases (38.3%) were male and 37 cases (61.7%) were females, with a female preponderance. The mean age was 27.33 years, with a SD of 93. In this study, maximum number of cases, i.e., 44 cases (73.3%) were seen in the age group of 19–28 years. Neck swelling was the chief presenting complaint among them followed by fever, 36 patients (60%), weight loss 31 (51.7%), anorexia in 28 (46.7%), and cough in 7 patients (11.7%). 75% patients improved after taking antitubercular therapy for 6 months and 5% patients not responded to the treatment till 8 months. Conclusion: There is high incidence of TB cervical lymphadenopathy in developing countries like India.

Background The current study aimed at observing the cyto morphological patterns in patients presenting with enlarged cervical lymph nodes, Delineate distribution of clinical diagnosis and to correlate them with fine needle aspiration cytology (FNAC), their distribution with age and gender specific distribution of various cytomorphological patterns of cervical lymphadenopathy. Materials and Methods Totally 60 consecutive patients presenting with cervical lymphadenopathy from September 2021 to August 2022, in the Department of ENT, Government Vellore Medical College, Vellore, Tamil Nadu, India, were enrolled into the current study. All patients >12 years of either sex who presented with cervical lymph node enlargement, following the exclusion of all cases where, <12 years of age, FNAC smears were inadequate or suboptimal for diagnostic interpretation. Based on clinical findings they are divided into 3 groups: Non specific, tubercular, neoplastic lymphadenitis. The clinical diagnosis was then correlated with FNAC diagnosis. Results Maximum number of cases (75%) presented with neck swelling of less than 3 months duration. The majority of the cases (98%) Presented with unilateral neck swelling. The majority of our patients (27%) Presented with level II neck nodes. In the majority of our patients the size of lymph nodes was less than 3 cms. Consistency of lymph nodes varied from soft to firm in about 46 patients . 10 Patients had hard neck nodes. In 45(80%) patients in our study had clinically mobile lymph nodes and there was fixity of lymph nodes in 11(20%) patients. In our study out of 45 patients who presented with mobile lymph nodes, 38 were discrete while 7 patients presented with matted lymph nodes. We made a clinical diagnosis of nonspecific cervical lymphadenopathy in 23 patients (41%), Tubercular lymphadenitis in 22 patients (39%),Neoplastic nodes in 11 patients (20%) Conclusion Cervical lymphadenopathy is a common occurrence and should be duly noted and a systemic approach should be followed to diagnose the cause which further helps in determining the proper treatment course for the patient. Mostly history and physical examination reveal the etiology for the same and hence should be taken into consideration while examining. When the cause of lymphadenopathy remains unexplained,a three to four weeks of observation period is appropriate when the clinical setting indicates high probability of benign disease. Thus a case of cervical lymphadenopathy has to be evaluated carefully to prevent any misdiagnosis. [ABSTRACT FROM AUTHOR]

Background: The microbiological diagnosis of extrapulmonary tuberculosis (TB) is quite difficult because of paucibacillary load and required radiological, cytohistopathological tests for confirmation along with clinical suspicion in case of cervical TB lymph node, body fluid examination such as pleural fluid, cerebrospinal fluid, ascitic fluid in cases of TB pleurisy, TB meningitis, and abdominal Koch's and was quiet challenging before inclusion of CBNAAT. Aims and Objectives: The aim of the study was to study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Materials and Methods: To study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel, and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Results: In this study, 23 cases (38.3%) were male and 37 cases (61.7%) were females, with a female preponderance. The mean age was 27.33 years, with a SD of 93. In this study, maximum number of cases, i.e., 44 cases (73.3%) were seen in the age group of 19-28 years. Neck swelling was the chief presenting complaint among them followed by fever, 36 patients (60%), weight loss 31 (51.7%), anorexia in 28 (46.7%), and cough in 7 patients (11.7%). 75% patients improved after taking antitubercular therapy for 6 months and 5% patients not responded to the treatment till 8 months. Conclusion: There is high incidence of TB cervical lymphadenopathy in developing countries like India. [ABSTRACT FROM AUTHOR]

Abstract Objective We aimed at evaluating the impact of ultrasound‐guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. Design and Methods Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H−) per operative US‐guided hook‐wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery‐related adverse events data were collected. Results Mean operative time was significantly shorter in H+ group versus H− group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H−, p = 0.1). No significant between group difference in surgery‐related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). Conclusion US‐guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H−.

Abstract Background Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist.

Abstract Background To explore the clinical and laboratory features, therapy and prognosis of Kikuchi–Fujimoto disease (KFD) in the cervical region. Methods We retrospectively reviewed the medical records of 134 patients who were diagnosed and treated with KFD from January 2000 to May 2022 in Fujian Medical University Union Hospital (Fujian, China). Their clinical characteristics, affected lymph node size, imaging examinations, and laboratory study results were analyzed. Results The mean patient age was 24.9 years, and the male–female ratio was 1:1.73. Fever (55.2%, n = 74) was the most common clinical manifestation. Leukopenia (49.3%) was the commonest reported laboratory abnormality. A majority (65.7%) of the 134 patients presented with bilateral nodal involvement. Conclusion KFD should be considered as a possible diagnosis in a female patient under the age of 30 presenting with cervical lymphadenopathy, fever, leukopenia, and elevated LDH. Level of Evidence 4.

Background: Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation: We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion: In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist. [ABSTRACT FROM AUTHOR]

Background: To explore the clinical and laboratory features, therapy and prognosis of Kikuchi–Fujimoto disease (KFD) in the cervical region. Methods: We retrospectively reviewed the medical records of 134 patients who were diagnosed and treated with KFD from January 2000 to May 2022 in Fujian Medical University Union Hospital (Fujian, China). Their clinical characteristics, affected lymph node size, imaging examinations, and laboratory study results were analyzed. Results: The mean patient age was 24.9 years, and the male–female ratio was 1:1.73. Fever (55.2%, n = 74) was the most common clinical manifestation. Leukopenia (49.3%) was the commonest reported laboratory abnormality. A majority (65.7%) of the 134 patients presented with bilateral nodal involvement. Conclusion: KFD should be considered as a possible diagnosis in a female patient under the age of 30 presenting with cervical lymphadenopathy, fever, leukopenia, and elevated LDH. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: We aimed at evaluating the impact of ultrasound‐guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. Design and Methods: Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H−) per operative US‐guided hook‐wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery‐related adverse events data were collected. Results: Mean operative time was significantly shorter in H+ group versus H− group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H−, p = 0.1). No significant between group difference in surgery‐related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). Conclusion: US‐guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H−. [ABSTRACT FROM AUTHOR]

Background: For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine-needle aspiration cytology (FNAC) is considered safe, less invasive, and cost-effective. However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy. Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. Results: FNAC had a sensitivity and specificity of 92% overall. Non-Hodgkin's lymphoma, tuberculosis, Hodgkin's lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively. Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination.

Primary malignant melanotic nerve sheath tumours, previously called Melanotic schwannomas are rare pigmented tumours of nerve sheath origin, with unspecified biologic behaviour and uncommon presentation in the head and neck region. A primary melanotic schwannoma of the cervical sympathetic plexus, mimicking a cervical lymphadenopathy requires careful evaluation and planning for an optimal outcome. The management of these neoplasms is still controversial, and hence we present a case report with insight into the diagnostic dilemma in work-up of a neck mass that turned out to be a Primary Malignant Melanotic Schwannoma arising from the cervical sympathetic plexus along with a review of literature. [ABSTRACT FROM AUTHOR]

Background: Thyroid dysfunction is the second most prevalent medical disorder which has impact on reproductive health and pregnancy outcome. Because of the link of thyroid auto antibodies with various pregnancy related complications and antithyroid peroxidase antibody (TPO Ab) being most common of all of them, can be used as a surrogate marker for thyroid related adverse pregnancy outcomes. Hence, this present study is designed to further elucidate any association of TPO Ab and TSH levesl with adverse pregnancy outcomes. Aims: The present study was undertaken to determine pregnancy outcomes between TPO Ab positive and negative hypothyroid mothers. Methods: This hospital based observational study was conducted in the Department of Gynaecology and Obstetrics, Raiganj Government Medical College, Uttar Dinajpur, West Bengal, India. 305 hypothyroid pregnant women at 1st trimester were chosen randomly between 1st June 2021 to 31st May 2022. The data was tabulated in Microsoft Excel software and analysed with SPSSV.20 software. Results: Maximum participants belonged to age group 15-20 years i.e. 115 (37.7%), followed by 21-25 years' age group, 92 (30.2%) Mean age of the participants was 23.30 years. Mothers with high TPO were 127 (41.6%). In our study 74 (24.3%) mothers required 25 mcg Levothyroxin followed by 12.5 mcg required for 58 (19%) mothers. GDM (27.78% vs 12.29%, p <0.001), were significantly higher in TPO Ab positive than TPO Ab negative hypothyroid mothers. Conclusions: Pregnant women with hypothyroidism and positive TPO Ab status were more predisposed to GDM than TPO Ab negative women. [ABSTRACT FROM AUTHOR]

Abstract Objective To determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings. Methods In this hospital‐based retrospective study, the demographic characteristics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)‐guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed. Results Of 241 patients 118 men and 123 women (mean age 27.9 ± 18.1 years) included in the study, 46.1% (n = 111) were diagnosed as necrotizing granulomatous lymphadenitis (caseified, consistent with TBL) and 21.6% (n = 12, atypical lymphoid cells and n = 40, metastases) as malignancy. The most common type of metastasis was squamous cell cancer (n = 31), and the primary source of most of them was esophageal cancer (16/31, 51.6%). The age of patients with TBL was significantly lower than that of non‐TBL (21.9 ± 14.6 vs. 41.9 ± 24.6, P = 0.003) and the incidence of TBL in pediatric patients was statistically higher (58.0% vs. 21.5%, P = 0.019). The rate of patients with TBL being localized at level 4 and level 5 was significantly more than non‐TBL patients (18.0% vs. 10.0% and 23.4% vs. 10.8%, respectively, P = 0.01). Half of patients with TBL who have chest radiography had pathological findings; consolidation and bronchopneumonia were present in 52.6% of them. There were 2 patients with paravertebral abscess and one patient with gastrointestinal tuberculosis. Conclusion In Somalia, in the presence of cervical lymphadenopathy, after diagnosis by using US‐guided biopsy; primarily considering of TBL and malignancy, thoracic involvement should be investigated, and esophageal carcinoma must be excluded in terms of metastatic lymph node.

Abstract Objectives To determine the prevalence of Castleman's disease (unicentric/idiopathic multicentric CD) in a retrospective cohort according to the newly defined international diagnostic criteria in patients, who underwent a lymph node removal at a tertiary care university hospital over a period of 10 years. Study design Retrospective chart review. Material and methods All Patients with cervical lymphadenopathy coded by ICD‐10‐CM with “I88.9,” “R59.0,” or “D47.Z2” between January 2010 and December 2020 and who underwent a lymph node extirpation were identified. In cases who met the diagnostic criteria for a potential unicentric or idiopathic multicentric CD (iMCD) diagnosis, the lymph node tissue was re‐evaluated by a pathologist. Results A total of 714 patients with cervical lymphadenopathy were included into this single‐center retrospective study. After exclusion of patients with diseases that may mimic iMCD and cases for which material to perform histological re‐evaluation was lacking, a subset of 75 patients with “nonspecific lymphadenitis” or “reactive hyperplasia of lymph node” was identified, who underwent a renewed histopathological examination. One case fulfilled both the major and minor criteria of an iMCD diagnosis, and further 15 cases matched the histological criterion of an iMCD diagnosis (one of the two major diagnostic criteria), so that a UCD diagnosis according to the new criteria could be accepted. Conclusion In this cohort, the subsequent application of the new diagnostic criteria led to further cases of CD (1.9% compared to 0.1% before) being recognized. Although incidence and prevalence of UCD and iMCD are low, clinicians should keep in mind this differential diagnosis as effective therapies are available. Level of Evidence 4.

Abstract Background An attempt was made to study ENT manifestations in tuberculosis. Material and methods A descriptive study was carried out among 200 patients with ENT manifestations of tuberculosis attending various departments at a government medical college hospital. Patients will be evaluated and followed up according to protocol. All patients diagnosed with tuberculosis were treated, according to the recent RNTCP guidelines using the CBNAAT testing. Results In the present study, 66% of patients with tuberculosis of the ear, nose, and throat region were females. Seventy-five percent of patients with tuberculosis of ENT and neck region were between the age group of 11 and 40 years. Cases of tubercular lymphadenitis (89.5%), tubercular laryngitis (4.5%), tubercular otitis media (3%), TB of the oral cavity (2%), and TB of the nose (1%) were seen. Painless lymph node enlargement was found in 91.62% of cases. Lymph node enlargement, hoarseness of voice, painless profuse otorrhoea, hearing loss, nasal obstruction, rhinorrhea, odynophagia, ulcers in the oral cavity, and tonsil enlargement were seen in patients of respective ENT tuberculosis. Concomitant pulmonary TB was found in 8.37% of cases of cervical TB, 100% of cases of laryngeal TB, 50% of cases of TB otitis media, 75% of cases of oral TB, and 50% of cases of nasal TB. Biopsy and CBNAAT have a promising role in tuberculosis management. Conclusion Early diagnosis of tuberculosis in ENT requires a high index of suspicion for patients non-responding to routine treatment

Background: Presence of cervical lymphadenopathy may indicate serious systemic disease process. Proper evaluation of cervical lymphadenopathy is of extreme clinical importance. Aims and Objective: The study objective was to evaluate clinical and demographic profile of cervical lymphadenopathy, to find the etiology, and to study the role of fine-needle aspiration cytology (FNAC) in it’s etiological diagnosis. Materials and Methods: Prospective observational study was carried out in a rural based teaching hospital in India for 1 year. One hundred and twenty-one patients of more than 12 years of age from both genders were included in the study. Detailed history, clinical, blood examination, radiological, microbiological evaluation, and FNAC from lymph node were done for all patients. Excision biopsy was done for selective cases. Results: It was a male predominant study with male: female ratio of 1.12:1 and mean age of the patient was 34.54 years. Cervical lymphadenopathy was mostly unilateral (77.69%) and it was more common in the right side (43.80%). Tuberculosis (TB) (36.37%) was the most common cause of cervical lymphadenopathy in our study followed by reactive hyperplasia of lymph node (23.14%) and metastatic deposit (19%). Among metastatic deposit, 9 (39.13%) had squamous cell carcinoma, 5 (21.74%) had adenocarcinoma, and 1 (4.35%) had small cell carcinoma. Conclusion: TB is the most common cause of cervical lymphadenopathy followed by reactive hyperplasia and metastatic secondary deposit. FNAC is a simple inexpensive relatively painless rapid and reliable method for diagnosis which can be considered as a frontline investigation and can guide requirement for further investigation in the management of cervical lymphadenopathy.

Abstract Background Cervical lymphadenopathy in children is a common problem in daily clinical practice. Many cases of cervical lymphadenopathy after the COVID-19 vaccine were reported. However, there is no yet reporting a case of supraclavicular cervical lymphadenopathy due to COVID-19. Case presentation A 12-year-old girl presented with fever, cough, fatigue, anosmia, and ageusia. COVID-19 was confirmed by real-time PCR. The symptoms were resolved within 10 days. Seven days later, she complained of supraclavicular swelling. Physical examination revealed painless, multiple, and mobile supraclavicular lymph nodes. Ultrasound and fine-needle aspiration cytology were suspicious. Therefore, an excisional biopsy of the largest node was performed. The specimen was sent for histopathology and immunohistochemistry evaluation which confirmed the benign nature of the lymph node. Conclusion To our best knowledge, this is the first case of supraclavicular lymphadenopathy in a child with COVID-19. It is essential to put COVID-19 in the differential diagnosis of cervical lymphadenopathy.

Abstract Background Accurate diagnosis of unexplained cervical lymphadenopathy (CLA) using medical images heavily relies on the experience of radiologists, which is even worse for CLA patients in underdeveloped countries and regions, because of lack of expertise and reliable medical history. This study aimed to develop a deep learning (DL) radiomics model based on B-mode and color Doppler ultrasound images for assisting radiologists to improve their diagnoses of the etiology of unexplained CLA. Methods Patients with unexplained CLA who received ultrasound examinations from three hospitals located in underdeveloped areas of China were retrospectively enrolled. They were all pathologically confirmed with reactive hyperplasia, tuberculous lymphadenitis, lymphoma, or metastatic carcinoma. By mimicking the diagnosis logic of radiologists, three DL sub-models were developed to achieve the primary diagnosis of benign and malignant, the secondary diagnosis of reactive hyperplasia and tuberculous lymphadenitis in benign candidates, and of lymphoma and metastatic carcinoma in malignant candidates, respectively. Then, a CLA hierarchical diagnostic model (CLA-HDM) integrating all sub-models was proposed to classify the specific etiology of each unexplained CLA. The assistant effectiveness of CLA-HDM was assessed by comparing six radiologists between without and with using the DL-based classification and heatmap guidance. Results A total of 763 patients with unexplained CLA were enrolled and were split into the training cohort (n=395), internal testing cohort (n=171), and external testing cohorts 1 (n=105) and 2 (n=92). The CLA-HDM for diagnosing four common etiologies of unexplained CLA achieved AUCs of 0.873 (95% CI: 0.838–0.908), 0.837 (95% CI: 0.789–0.889), and 0.840 (95% CI: 0.789–0.898) in the three testing cohorts, respectively, which was systematically more accurate than all the participating radiologists. With its assistance, the accuracy, sensitivity, and specificity of six radiologists with different levels of experience were generally improved, reducing the false-negative rate of 2.2–10% and the false-positive rate of 0.7–3.1%. Conclusions Multi-cohort testing demonstrated our DL model integrating dual-modality ultrasound images achieved accurate diagnosis of unexplained CLA. With its assistance, the gap between radiologists with different levels of experience was narrowed, which is potentially of great significance for benefiting CLA patients in underdeveloped countries and regions worldwide.

Objective: Several clinical practice guidelines have been produced and disseminated for the evaluation of a neck mass. However, to date, the quality and methodologic rigor of these clinical practice guidelines have not been appraised. Therefore, this study set out to identify and assess the methodologic quality of national and international guidelines for the evaluation and management of neck masses in adults. Methods: We conducted a comprehensive search of EMBASE, MEDLINE/PubMed, SCOPUS and grey literature sources until September 2020. The quality of these guidelines was assessed by four reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Domain scores were considered acceptable quality if they scored >60%, and Intraclass Correlation Coefficients (ICC) were calculated to assess agreement among the appraisers. Results: Seven guidelines were assessed for evaluation. Among these, only the American Academy of Otolaryngology (AAO), Cancer Care Manitoba (CCMB), and the American Society of Clinical Oncology (ASCO) achieved an overall rating of “high”. The remaining four guidelines achieved ratings of either “average” or “low”. The “Scope and Purpose” domain achieved the highest mean score (94.4% ± 5.0%), and lowest was “Applicability” (51.5% ± 29.2%). ICC analysis showed substantial to very good agreement across all domains (0.75–0.98). Conclusion: These findings highlight the variability in methodologic quality of guidelines for the evaluation and management of adult neck mass. The results from this analysis highlight the need to improve guidelines development process for this topic and may guide the selection and use of these guidelines in clinical practice.

Mycobacterium genavense infection, a rare nontuberculous mycobacteria infection, occurs in heavily immunocompromised patients (i.e., those with advanced HIV disease, genetic disorders, or acquired immunologic disorders and those undergoing immunosuppressive therapy). We report a case of disseminated M. genavense infection preceding Hodgkin lymphoma in a patient without obvious risk factors for this infection.

Rosai-Dorfman disease (RDD), a rare form of non-Langerhans cell histiocytosis, can involve systemic extranodal lesions. Skin lesions are the most common, whereas intrapelvic, cardiac, and hepatic lesions are infrequent. The present study describes a 74-year-old woman with multiple extranodal lesions in the pelvis, heart, liver, and skin that were successfully treated with glucocorticoid therapy. She had experienced fever and persistent inflammation without cervical lymphadenopathy for several months and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) showed abnormal FDG uptake in the left cheek; cervical, axillary, inguinal lymph nodes; periatrium; and pelvis. She was diagnosed with RDD based on skin and pelvic biopsies. Although this was an atypical case without bilateral cervical lymphadenopathy, the FDG-PET detection of inflammatory lesions led to selection of suitable biopsy sites, and pathological examination led to a correct diagnosis. Findings in this patient indicate that RDD can present with an atypical distribution of infrequent extranodal lesions, with attention required to prevent a delayed diagnosis. [ABSTRACT FROM AUTHOR]

Background: Lymph node enlargement is a normal age related physiological change, may also herald chronic infections and serious conditions like autoimmune disorders. Etiology varies from region to region. However few studies have emphasized on the clinico- pathological correlation. Material and Methods: This is a Prospective study in a tertiary care hospital setting. Seventy consecutive children reporting to the Department of Pediatrics, Narayana Medical College, Nellore November 2020 to October 2021 were studied. FNAC, Mantoux test and hematological parameters were performed in all the cases. Additional investigations like culture, serological test and roentgenogram were done wherever required. Results: Among 70 cases the common age group was 4year to 8 years in 41.4% children .The etiology was confirmed in 84.3% cases and could not be ascertained in 21.4 % cases even after relevant investigations. Cytological examination revealed reactive lymphadenitis in 74.3% cases, tubercular lymphadenitis in 14.3% cases and Suppurative lymphadenitis in 7.1% cases, 4.3% cases yielded inadequate aspirate. Commonest etiology diagnosed after detailed investigation was due to infections in areas of drainage like tonsils, ear and scalp, oral cavity in 38.5% cases followed by tuberculosis in 24.2% cases. In addition, there were 12.8% cases of HIV, 2.9% cases were measles. Sensitivity of FNAC in TB was 58.9%. Conclusion: Reactive lymphadenitis due to underlying infection caused by streptococcal and staphylococcal infections were the commonest treatable entity of significant pediatric cervical lymphadenopathy. Further studies and longer follow-up involving detection of antigen and antibodies against lesser known viruses, parasites and rarer causes of lymphadenopathy may decrease the fraction of undiagnosed reactive conditions . [ABSTRACT FROM AUTHOR]

Background: For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine-needle aspiration cytology (FNAC) is considered safe, less invasive, and cost-effective. However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy. Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. Results: FNAC had a sensitivity and specificity of 92% overall. Non-Hodgkin's lymphoma, tuberculosis, Hodgkin's lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively. Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination. [ABSTRACT FROM AUTHOR]

Objective: Cervical lymphadenopathy (LAP) is one of the most common pathologies in adults and children. While ultrasonography (USG) and fine needle aspiration biopsy (FNAB) are the two methods used as diagnostic tests, excisional biopsy is the gold standard method for diagnosis. In this study, we aimed to show the relationship between USG findings and FNAB results with malignancy in patients with LAP. Materials and methods: Patients who visited our clinic with the complaint of cervical LAP between March 2020 and September 2022 and underwent excisional biopsy were included in this retrospective study. The number, distribution, side, size, cortical thickness, conglomeration, and necrosis characteristics of LAP were evaluated on USG. The sensitivity and specificity of the FNAB were calculated in patients in accordance with the histopathological results. Results: Of the patients included in the study, 45 were female and 42 were male. The overall mean age was 32.72 ± 20.02. The sensitivity of the FNAB was 43.5% and the specificity was 90.0%. Advanced age, presence of conglomeration, unilateral LAP, and generalized LAP were found to be statistically significant in terms of malignancy, while cortical thickness, the number and size of LAPs, and necrosis were not statistically significant. Conclusion: FNAB was not found to be a reliable test to rule out malignancy due to low sensitivity for determining malignancy and but was found to be a highly selective test, and the malignancy-suspected result detected the real patients quite successfully. The advanced age, unilateral LAP, generalized distribution, and conglomeration were the parameters supporting malignancy. [ABSTRACT FROM AUTHOR]

Background: India has the highest incidence of tuberculosis in the globe, with twenty percent of cases. In India, tuberculous lymphadenitis is the most prevalent extrapulmonary variant of tuberculosis. The purpose of this study is to share our knowledge regarding tuberculous cervical lymphadenitis. Methods: This hospital-based prospective investigation was conducted for one year in the Department of General Surgery at MRMCH, Daltonganj. All cases of neck edoema or cervical lymphadenitis selected for the study were initially treated conservatively with antibiotics and evaluated after two weeks. If the neck edoema persists, FNAC, USG, and occasionally a biopsy are performed. Results: Out of 120 study cases, infectious or inflammatory aetiology was observed in 47.5%, tuberculous lymphadenopathy in 33.333%, metastatic nodes in 13.335%, lymphoma in 1.67%, and non-specific lymphadenitis in 4.17 % of cases. Analysis of 40 cases of tuberculous lymphadenopathy revealed that those between the ages of 15 and 24 were most frequently affected. 68% of the cases were female and 32% were male. Level V cervical lymph nodes were most commonly involved. Ultrasonography of tuberculous lymph nodes revealed hypoechogenicity and necrosis in all cases, matted lymph nodes in forty percent of cases, calcifications in twenty-seven percent of cases, and pointed margins in sixty-seven percent of cases. Tests for tuberculin were only positive in 73% of cases. Conclusion: In developing nations like India, there is a high prevalence of tuberculous cervical lymphadenitis among patients with enlarged neck lymph nodes. Adenopathy of the cervical lymph nodes is the most prevalent manifestation of the extrapulmonary form of tuberculosis. Therefore, it is essential that otolaryngologists are aware of tuberculosis in the head and neck region, which can aid in early diagnosis with the assistance of simple investigations, allowing patients to be promptly and effectively treated.

Accurate differentiation of benign and malignant cervical lymph nodes is important for prognosis and treatment planning in patients with head and neck squamous cell carcinoma. We evaluated the diagnostic performance of magnetic resonance image (MRI) texture analysis and traditional 18F-deoxyglucose positron emission tomography (FDG-PET) features. This retrospective study included 21 patients with head and neck squamous cell carcinoma. We used texture analysis of MRI and FDG-PET features to evaluate 109 histologically confirmed cervical lymph nodes (41 metastatic, 68 benign). Predictive models were evaluated using area under the curve (AUC). Significant differences were observed between benign and malignant cervical lymph nodes for 36 of 41 texture features (p < 0.05). A combination of 22 MRI texture features discriminated benign and malignant nodal disease with AUC, sensitivity, and specificity of 0.952, 92.7%, and 86.7%, which was comparable to maximum short-axis diameter, lymph node morphology, and maximum standard uptake value (SUVmax). The addition of MRI texture features to traditional FDG-PET features differentiated these groups with the greatest AUC, sensitivity, and specificity (0.989, 97.5%, and 94.1%). The addition of the MRI texture feature to lymph node morphology improved nodal assessment specificity from 70.6% to 88.2% among FDG-PET indeterminate lymph nodes. Texture features are useful for differentiating benign and malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Lymph node morphology and SUVmax remain accurate tools. Specificity is improved by the addition of MRI texture features among FDG-PET indeterminate lymph nodes. This approach is useful for differentiating benign and malignant cervical lymph nodes.

Background: Cervical lymphadenopathy is one among the common presentations in ENT OPD with its causes ranging from mild infections to life-threatening malignancies. Materials and methods: About 50 patients presenting to ENT OPD with cervical lymphadenopathy were selected after taking informed consent. Routine clinical laboratory and pathological investigations were done. Radiological investigations and open biopsy were done if required. Results: Reactive and malignancy cases accounted for the most cases, contributing 68% (34 out of 50) of all cases, or 34% each. Only a quarter of the cases (12 out of 50) were due to tuberculosis. Out of 50 cases, only two were diagnosed with lymphoma and nonspecific lymphadenitis. In this investigation, out of 50 cases, 44 cases diagnosed clinically matched the FNAC findings, whereas 6 cases were found to be different, resulting in 88% clinical diagnostic accuracy. And 43 of the radiologically diagnosed patients had the same FNAC diagnosis, while 7 of them differed on cytological analysis, resulting in 86% radiological diagnostic accuracy. Conclusion: Clinical evaluation followed by FNAC aids in the diagnosis of a case of cervical lymphadenopathy and can serve as a record for future care. For the diagnosis and treatment of the underlying cause, a thorough clinical examination and thorough investigations are required. If the diagnosis is delayed, the underlying cause may become incurable. [ABSTRACT FROM AUTHOR]

Background. Fine-needle aspiration cytology (FNAC) is the basic investigation that can be performed even in small centers, with low costs, without major complications and with good patient compliance. The broad spectrum of diseases can be classified into inflammatory conditions, malignancies or lymphoma, which allows the planning of the treatment strategy or further investigation that is necessary for diagnosis. Materials and Methods. A prospective study was performed on 100 individuals with enlarged cervical lymph nodes who underwent FNAC and surgery, from 2017 to 2019. The histopathological reports of the patients were correlated with the preoperative cytological reports. Results. Of the studied cases, reactive lymphadenopathy was the most common - 43%, followed by tuberculous lymphadenopathy - 21%, granulomatous lymphadenopathy - 16%, and malignancy - 16%. Among malignancy, the most common is the secondary from squamous cell carcinoma – 11 cases (68.75%) followed by metastasis from thyroid carcinoma – 4 cases (25%) and metastasis from adenocarcinoma – 1 case (6.25%). By the age of 40, the most common malignancy is metastasis from thyroid carcinoma, while over 40, the secondary tumor from squamous cell carcinoma is the most common. Sensitivity, specificity and accuracy of FNAC are high in carcinomatous (93.75%, 100%, 99%), lymphomatous (75%, 98.96%, 98%) and tuberculous lymphadenopathy (95.24%, 96.20%, 96%). Conclusions. FNAC is a simple and safe test, with a good accuracy of diagnosis and low complications, being therefore an effective diagnostic tool.

Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.

Rosai–Dorfman disease (RDD) is also known as Sinus Histiocytosis with Massive Lymphadenopathy. It is a rare, benign, self-limiting disease of phagocytic histiocytes presenting with massive painless cervical lymphadenopathy. RDD can present as a nodal disease and also extra-nodal involvement with episodes of exacerbation and remissions and relapses after treatment. Its etiology remains poorly understood and is highly variable in its clinical presentation and response to treatment. Its treatment is poorly defined but the prognosis is usually fair. Here we are reporting a rare, unusual clinical presentation of infraorbital soft tissue mass diagnosed as RDD with cyto-histopathological correlation. Only a few such cases have been reported in the literature. [ABSTRACT FROM AUTHOR]