Cases reported "Lymphatic Diseases"

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1/75. granuloma inguinale (donovanosis) presenting as a neck mass in an infant.

    A case of granuloma inguinale (GI) presenting as a lateral neck mass in a 4-month-old, hiv-positive infant is described. The histological features of the mass were typical of GI, with numerous macrophages containing intracellular organisms with a "closed-safety-pin" appearance. This is a rare occurrence, and the mode of transmission of infection is discussed. An awareness of GI in infants by both clinicians and pathologists is important to prevent morbidity and allow for prompt institution of appropriate treatment.
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2/75. Primary amyloidosis presenting as massive cervical lymphadenopathy with severe dyspnea: a case report and review of the literature.

    amyloidosis is an end point of several diseases in which the unifying characteristic is the association and extracellular deposition of the insoluble protein fibrils within various tissues and organs. We have discussed a variety of clinical findings of primary amyloidosis with emphasis on its otolaryngologic manifestations. This case represents the second report in the literature of a neck mass resulting from a plasma cell dyscrasia and the first report of AL disease producing such extensive cervical lymphadenopathy as to cause significant respiratory compromise.
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3/75. Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) of the pancreas: first case report.

    Rosai-Dorfman disease is a histiocytic proliferative disorder which primarily affects lymph nodes. Extranodal involvement occurs in about one half of the patients and the head and neck area represents the region most commonly involved. We present the case of a 48 year-old female who was found with a pancreatic mass during evaluation for abdominal pain. She underwent a distal pancreatectomy and splenectomy. Her pathology showed sinus histiocytosis with massive lymphadenopathy (SHML) involving the pancreas and lymph nodes and focally the spleen. The histiocytes characteristically contained one or more viable lymphocytes in the cytoplasm. The lymphocytes had penetrated the cytoplasm in a process known as "emperipolesis", where the lymphocytes continued to have free movement in the histiocyte. The histiocytic cells were positive with S-100 protein and CD68. Rosai-Dorfman disease (SHML) can affect the peripancreatic lymph nodes with possible secondary pancreatic involvement and present as a pancreatic mass.
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4/75. Spurious diagnosis of a cervical mass due to a laryngeal mask airway.

    The laryngeal mask airway (LMA) has become a popular alternative to endotracheal intubation. We report a case in which appropriate LMA placement resulted in an unrecognized neck mass and subsequent erroneous diagnosis of cervical lymphadenopathy. Otolaryngologists should be aware that the LMA may result in alterations of neck anatomy.
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5/75. Ectopic thymus presenting as a solid submandibular neck mass in an infant: case report and review of literature.

    Solid ectopic cervical thymus is an extremely uncommon etiology of a neck mass in an infant. It occurs in the line of descent of the thymus from the angle of the mandible to the superior mediastinum. Nine cases of ectopic cervical thymus in infants have been reported in the literature. Only two of nine cases were solid, the remaining seven were thymic cysts. A preoperative diagnosis is seldom considered and is often misdiagnosed as a possible malignancy or a lymph node. We present a case of a 2-month-old infant with an asymptomatic enlarging right neck mass. Patient underwent complete excision of the mass.
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6/75. Fine needle aspiration biopsy of pediatric head and neck masses.

    OBJECTIVE: To determine if fine needle aspiration (FNA) can preclude the requirement for diagnostic open biopsy in suspicious pediatric head and neck masses. methods: The records of 40 children presenting to an inner city tertiary care hospital who underwent a total of 50 FNA biopsies during the years 1988-1999 were reviewed. From these 40 patients, 17 children, aged 3 months to 18 years, underwent both clinically indicated FNA biopsy and subsequent open surgical biopsy or excision. Outcome measurements included clinical resolution or surgical pathologic diagnosis. RESULTS: The 17 patients who underwent open surgical biopsy subsequent to the FNA had a total of 21 FNAs performed. Three of these patients had more than one needle biopsy prior to surgery. The histologic diagnosis of the surgical excision confirmed the FNA biopsy cytologic diagnosis in all but two cases. FNA cytologic diagnostic categories included reactive lymph node/non-specific inflammation (25 biopsies), benign cystic process (four), granulomatous disease (eight), malignant neoplasm (three), and benign neoplasm (one). Eight of nine FNAs initially non-diagnostic had either complete resolution of the mass or a diagnosis obtained by subsequent FNA or open biopsy. CONCLUSIONS: FNA is a valuable diagnostic tool in the management of children with the clinical presentation of a suspicious neck mass. The technique reduces the need for more invasive and costly procedures. Early surgical biopsy, however, should be considered in rapidly enlarging masses, in the presence of persistent systemic symptoms, and when repeated FNA cytology is non-diagnostic.
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7/75. Vascular transformation of lymph node sinuses.

    Vascular transformation of lymph node sinuses is an uncommon condition and only isolated cases have been reported. It is characterized by conversion of nodal sinuses into capillary-like channels, often accompanied by fibrosis. Venous or lymphatic obstruction is thought to be the underlying mechanism, and in most cases factors that may contribute to lymphovascular obstruction can be identified such as tumour in the vicinity, vascular thrombosis, heart failure, previous surgery or radiotherapy. Most cases involve abdominal lymph nodes, and head and neck involvement is rare. We present two cases of vascular transformation of lymph node sinuses presenting only as cervical lymphadenopathy, without an obvious cause of lymphovascular obstruction.
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8/75. Rosai-Dorfman disease of the parotid gland: cytologic and histopathologic findings with immunohistochemical correlation.

    Rosai-Dorfman disease is a rare histiocytic proliferative disorder of unknown origin and a distinct clinicopathologic entity also known as sinus histiocytosis with massive lymphadenopathy. The disease can involve extranodal tissues and rarely can present as salivary gland enlargement without significant lymphadenopathy. Involvement of the extranodal head and neck sites appears to be more common in patients with immunologic abnormalities. The disease was first described in 4 patients in 1969, and with later descriptions of more patients, the disease was established as a well-defined clinicopathologic entity. The characteristic pathologic feature of this disease is proliferation of distinctive histiocytic cells that demonstrate emperipolesis in the background of a mixed inflammatory infiltrate, consisting of moderately abundant plasma cells and lymphocytes. Fine-needle aspiration biopsy can be helpful in establishing the correct diagnosis, since surgical treatment is not necessary other than obtaining tissue for definitive diagnosis. We describe cytologic, histopathologic, and immunohistochemical features of a case of Rosai-Dorfman disease that involved a major salivary gland without significant lymphadenopathy in a 48-year-old patient with systemic lupus erythematosus. We also briefly discuss possible causes and pathogenesis and review the literature.
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9/75. thoracic duct cyst presenting as an hour-glass shaped mass in the left supraclavicular area: case report.

    thoracic duct cyst presenting as an hour-glass shaped mass in the left supraclavicular area: case report. thoracic duct cysts are a very rare entity in the head and neck pathology. We present a case of a 52 year-old man, who was referred to our service, complaining by a 30 days left cervical mass, with no other symptoms. A 6 cm cystic mass was revealed after ultrasonography and CT. Needle aspiration confirmed the presence of lymph in the cyst. The treatment was simple excision. Special care was taken to ligate the connected lymphatic vessels.
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10/75. Management of a giant lymphatic malformation of the tongue.

    Lymphatic malformations can occur anywhere in the head and neck, and when they do so in the oral cavity, they can present a potential hazard to the airway. We describe a 4-year-old girl with a giant lymphatic malformation of the tongue and neck. This report illustrates the particular difficulties that may be encountered in cases involving giant lymphatic malformations of the cervicofacial region in the pediatric population. An overview of the etiology, diagnosis, histology, and options for the management of such lesions is outlined.
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