A giant leiomyoma of the breast

Breast leiomyoma is a rare benign tumor arising from the nipple and/or areola or from smooth muscle metaplasia of myoepithelial or myofibroblast cells. Despite its benign morphology, breast leiomyoma can create diagnostic confusion. Here, we report a rare case of a single leiomyoma of the breast in a 52-year-old woman. The patient reported a lump in her right breast for 1 year, and in the past 6 months, it has grown in size. Physical examination showed a dense mass in the right breast, without axillary lymphadenomegaly. Excisional biopsy revealed a well-defined cell tumor by intertwining the spindle cell folds with fibrillar and eosinophilic cytoplasm. Histopathological and immunohistochemical studies help to discriminate between leiomyoma and other benign and malignant breast lesions. Her results are discussed in our report.

Juvenile lupus, cytomegalovirus infection and cardiac tamponade: case report

ABSTRACT Objective: To describe a rare case of cardiac tamponade in a pediatric patient with systemic lupus erythematosus (SLE) and cytomegalovirus (CMV) infection, and to discuss the relationship between these morbidities, the diagnostic approach, and the possible treatments. Case description: A 9-year-old girl presented to the emergency department with severe dyspnea, muffled heart sounds, jugular vein distention, hemodynamic instability, and intense pallor. She had previously been followed up at the outpatient clinic for a six-month history of mild respiratory distress, polyarthritis, fever, and various cutaneous manifestations. Doppler echocardiogram revealed pericardial effusion. The patient was submitted to pericardiocentesis followed by water seal pleuropericardial drainage, with no complications. The investigation continued, with fulfillment of clinical and laboratory SLE criteria plus CMV antigenemia of 15/200,000 cells. Medications to control CMV infection and SLE were then initiated, with good clinical and laboratory response. Comments: Pediatric SLE commonly manifests in a more severe form, accounting for high morbimortality. Cardiac tamponade could be one of the first manifestations of SLE, which can also be precipitated by infectious agents, such as CMV, leading to diagnostic confusion and misleading the treatment. Changes in therapeutics must also be considered in the presence of both conditions. This study presents a juvenile SLE case aggravated by a CMV infection with the unusual manifestation of cardiac tamponade.%

Clinico-radiological and pathological correlation of interstitial lung diseases: a prospective single centre study

Background: Current investigation was done to study the role of HRCT chest in the diagnosis and characterization of interstitial lung diseases, yield of transbronchial lung biopsy and role of multidisciplinary approach of diagnosis.Methods: We prospectively analyzed clinical features and radiological findings in 38 patients of ILD. Radiological diagnosis on HRCT was made in every case depending on type of predominant abnormality and pattern of involvement. Following this, TBLB was done in every case.Results: ILD was diagnosed in all cases on HRCT. Most common ILD type was UIP (31.5%) followed by sarcoidosis (21%) and NSIP (15.7%). Other ILD subtypes encountered were, RB-ILD, AIP and acute silicosis. In 68.4% cases, there was definitive diagnosis on TBLB. Out of which in 15.7% cases, HRCT and TBLB diagnosis were different. In 15.3% cases, TBLB gave diagnosis of only non- specific ILD.Conclusions: HRCT can detect ILD in 100% cases & can characterize ILD into various patterns. But, HRCT alone without clinical correlation and pathology can cause diagnostic confusion in many cases. However, multidisciplinary approach by engaging clinician, radiologist and pathologist can lead to accurate diagnosis in many cases of ILD. TBLB is a safe, minimally invasive procedure which can establish correct diagnosis in many cases especially in broncho-centric diseases.

Spanish version of the Frontotemporal Dementia Knowledge Scale: adaptation and validation

ABSTRACT Background: Frontotemporal dementia (FTD) is a neurodegenerative disease and is one of the most common causes of dementia in people under 65. There is often a significant diagnostic delay, as FTD can be confused with other psychiatric conditions. A lack of knowledge regarding FTD by health professionals is one possible cause for this diagnostic confusion. Objectives: The aim of this study was to adapt and validate the Frontotemporal Dementia Knowledge Scale (FTDKS) in Spanish. Methods: A translation was done, following cross-cultural adaptation guidelines, which consisted of forward translation, blind back translation, and an analysis by a committee of experts. For the present study, 134 professionals from different health areas responded the Spanish version of the FTDKS. The statistical analysis was performed using R version 4.0.0 “Arbor day” and the Psych, sjPlot packages. Results: The Spanish version of the FTDKS had good reliability and internal consistency (Cronbach alpha 0.74.). The sample's mean score was 19.78 (range = 4-32, SD 6.3) out of a maximum of 36 points. Conclusions: The results obtained show that the Spanish version has good psychometric properties. The FTDKS is applicable in our environment and can be a useful tool to evaluate the knowledge of health professionals regarding frontotemporal dementia.

Axillary Adenopathy Secondary to SARS-CoV-2 Vaccination: a Case Report

Introduction: SARS-CoV-2 mRNA vaccines are safe and effective for the prevention of COVID-19 infection, though local reactions are commonly reported. Axillary lymphadenopathy has also been reported, which has the potential of causing diagnostic confusion and unnecessary testing and procedures. Case Description: A 58 year-old female with untreated latent tuberculosis was noted to have a pulmonary nodule on chest radiograph. Evaluation for Mycobacterium tuberculosis was undertaken, and a FDG PET/CT was performed to rule out malignancy. While the nodule demonstrated low avidity, highly avid lymph nodes were noted in the left axillary region. Further questioning elicited a recent history of mRNA-1273 (Moderna) COVID-19 vaccination in her left deltoid muscle three weeks prior, and a sensation of axillary fullness. She was managed conservatively with spontaneous resolution of her lymphadenopathy. Conclusions: Axillary lymphadenopathy following mRNA vaccination has been reported, and appears to be more common with mRNA-1273 (Moderna) than BNT162b2 vaccine (Pfizer-BioNTech), in those aged 18 to 64 as compared to age ≥65, and following the second vaccine dose compared to the first dose. Vaccination should be considered in the differential diagnosis of axillary lymphadenopathy, particularly ipsilateral to the vaccination site, to avoid unnecessary testing, treatment, and patient anxiety.

PARVOVIRUS B19 INDUCED MYOCARDITIS, SIMULATING ACUTE MYOCARDIAL INFARCTION

Myocarditis is an inflammation of the myocardium associated with mechanical or electrical dysfunctions that usually lead to inappropriate ventricular dilatation or hypertrophy. A number of inciting factors are known to cause myocarditis- genetic defects, viruses, bacteria, parasites, granulomatous inflammations, collagen vascular disorders, chemotherapeutic agents- to name a few. Among the viruses, Adenovirus, Coxsackie virus, Human Herpes virus six and Parvovirus B19 are the encountered pathogens. We hereby present a case of a 14 years old boy who presented with typical cardiac chest pain associated with electrocardiographic changes of ST segment elevation MI in theinferior leads. Cardiac biomarkers were elevated, adding to the diagnostic confusion of MI. On subjecting the patient to a coronary angiography, his arteries were found to be patent, directing us towards the diagnosis of myocarditis. After getting a cardiac MRI and serum tests, the diagnosis of fulminant myocarditis induced by Parvovirus B19 was made. Fortunately, the patient survived on inotropes and other supportive therapy which helped him overcome the cardiac failure.

Nodal mycobacterial spindle cell pseudotumor: A diagnostic pitfall

Inflammatory pseudotumor (IPT) is a rare benign mass forming lesion that has been reported in virtually every organ, and can closely mimic spindle cell neoplasms. Mycobacterial spindle cell pseudotumor (MSP) represents a small proportion of IPT of the lymph node, which occur in immunocompromised patients, posing a diagnostic challenge. We report three cases of MSP involving two AIDS patients who presented with generalized lymphadenopathy, and one immunosuppressed patient with a mediastinal mass. Biopsy in these cases revealed effaced architecture replaced by proliferating fibrohistiocytic spindle cells, fibrosis and polymorphic inflammatory infiltrate. Inflammatory pseudotumors and other spindle cell neoplasms of the lymph node can show overlapping morphologic features, resulting in diagnostic confusion. A differential diagnosis of Mycobacterial spindle cell pseudotumor should be kept in mind when approaching localized or generalized lymphadenopathy in an immunocompromised patient.