Search Results (57)

Introduction: The evaluation of lymph nodes (LNs) in patients with suspected oncological disease is a crucial factor influencing further diagnostics and management. However, there is a lack of a dedicated system for the precise and comprehensive assessment of LNs. To address this gap, we developed the Lymph Node Reporting and Data System (LN-RADS). Methods: This retrospective multiparametric analysis included the assessment of 719 LNs in 489 patients. The images were evaluated by three radiologists using the LN-RADS scale, assigning each case to one of six group: 1 (normal), 2 (steatotic), 3 (reactive), 4a (low suspicion of malignancy) vs. 4b (high suspicion of malignancy), and 5 (definitely malignant) and were then correlated with histopathological results. The diagnostic performance of LN-RADS was validated. The analysis of 12 morphological features of LNs was performed to identify predictors of malignancy. Results: Histopathological analysis confirmed 389 malignant and 330 benign LNs. LN-RADS achieved 89% sensitivity, 85% specificity, and 87% accuracy in the diagnosis of malignant LN. The observed risk of malignancy by group was 0% for LN-RADS 1, 0% for LN-RADS 2, 2% for LN-RADS 3, 31% for LN-RADS 4a, 77% for LN-RADS 4b, and 97% for LN-RADS 5. Cohen’s kappa statistic indicated substantial inter-reader agreement. Among the evaluated features, the strongest predictor of malignancy was the cortex thickness diameter, with a threshold value of ≥6 mm (82% accuracy; AUC = 0.894). Conclusions: This study demonstrated the high efficacy of the LN-RADS system in distinguishing between benign and malignant lymph nodes and in stratifying malignancy risk. It also showed substantial inter-rater agreement. Full article

Background/Objectives: Lymph node (LN) evaluation is critical in diagnosing, staging, and managing various diseases, particularly lymphoma and metastatic cancer. Although conventional ultrasound (US) is widely used for this purpose, its limitations in reliably differentiating between benign and malignant LNs persist. Ultrasound elastography (US-E), which evaluates tissue stiffness, has emerged as a promising adjunct to improve diagnostic accuracy. This study aims to evaluate the diagnostic performance of conventional US, power Doppler US, and strain elastography (SE) in distinguishing malignant from benign superficial lymph nodes. Methods: In this prospective study, 214 consecutive patients referred for US of enlarged LNs were enrolled. Conventional B-mode US, power Doppler, and SE were performed, and the strain ratio (SR) was calculated as a measure of LN stiffness. Histopathological examination was used as the reference standard. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis, and multivariable logistic regression models were applied to determine the independent predictive role of SR. Results: Among the 214 LNs (one for each patient), 74 (34.6%) were benign and 140 (65.4%) were malignant. The SR showed a significant association with malignancy (p < 0.001). For hematological malignancies, SR demonstrated high sensitivity (79–85%) and specificity (81–96%), with an overall area under the curve (AUC) of 0.91. Multivariable analysis confirmed that SR was an independent predictor of malignancy (continuous and dichotomous), with a 14% gain in predictive accuracy when treated as a continuous variable (p < 0.0001). Conclusions: US-E, particularly SR, is a valuable tool in the differentiation of benign and malignant superficial LNs. SR provides significant diagnostic value, especially in hematological neoplasms like Hodgkin lymphoma, and can serve as an independent predictor of malignancy. This technique, when used in combination with conventional US features, offers enhanced diagnostic performance for LN evaluation. Full article

Lymphadenomegaly is well described in dogs with neoplastic diseases but can also reflect inflammation. However, its role in assessments of inflammation is little reported in the veterinary literature. Lymph nodes are most easily assessed superficially through palpation, but computed tomography (CT) enables the evaluation of deep lymph nodes. Accordingly, we investigated associations between the maximal lymph node diameter and plasma concentrations of C-reactive protein (CRP) and white blood cell (WBC) count, as inflammatory markers, targeting three deep lymph nodes (sternal, cranial mediastinal, and internal iliac). We evaluated data from small dogs with non-neoplastic diseases that underwent synchronous CT and blood biochemistry at our institution. We found that the sternal lymph node diameter was significantly greater in dogs with clinically elevated CRP than those with clinically unremarkable CRP (p = 0.04) and significantly correlated with CRP (r = 0.32; p < 0.01). We found no significant association with CRP for the cranial mediastinal or internal iliac lymph node. Thus, we consider CT-measured sternal lymphadenomegaly a clinically valuable finding for the comprehensive evaluation of systemic inflammation. We anticipate further research may highlight the utility of CT lymph node measurements for such evaluations. Full article

Background/Objectives: Even with today’s advancements, cancer still represents a major cause of mortality worldwide. One important aspect of cancer progression that has a big impact on diagnosis, prognosis, and treatment plans is accurate lymph node metastasis evaluation. However, regardless of the imaging method used, this process is challenging and time-consuming. This research aimed to develop and validate an automatic detection and segmentation system for superficial lymph node evaluation based on multimodal ultrasound images, such as traditional B-mode, Doppler, and elastography, using deep learning techniques. Methods: The suggested approach incorporated a Mask R-CNN architecture designed specifically for the detection and segmentation of lymph nodes. The pipeline first involved noise reduction preprocessing, after which morphological and textural feature segmentation and analysis were performed. Vascularity and stiffness parameters were further examined in Doppler and elastography pictures. Metrics, including accuracy, mean average precision (mAP), and dice coefficient, were used to assess the system’s performance during training and validation on a carefully selected dataset of annotated ultrasound pictures. Results: During testing, the Mask R-CNN model showed an accuracy of 92.56%, a COCO AP score of 60.7 and a validation score of 64. Furter on, to improve diagnostic capabilities, Doppler and elastography data were added. This allowed for improved performance across several types of ultrasound images and provided thorough insights into the morphology, vascularity, and stiffness of lymph nodes. Conclusions: This paper offers a novel use of deep learning for automated lymph node assessment in ultrasound imaging. This system offers a dependable tool for doctors to evaluate lymph node metastases efficiently by fusing sophisticated segmentation techniques with multimodal image processing. It has the potential to greatly enhance patient outcomes and diagnostic accuracy. Full article

Background/Objectives: Simultaneous vascularized lymph node transfer (VLNT) and breast reconstruction is a reconstructive option that potentially addresses two adverse consequences of breast cancer treatment in the same operation. This systematic review aims to analyze the quality of data and outcomes in the current literature. Methods: This systematic review was performed following PRISMA guidelines. A systematic search was conducted with Google Scholar and PubMed for studies with the simultaneous intervention of VLNT and breast reconstruction. The search terms were ((diep OR pap OR expander OR implant OR breast OR msTRAM OR TRAM) AND (“vascularized lymph node”)). Studies were included if they were original articles that discussed patients who underwent simultaneous VLNT and breast reconstruction. Additional sources were identified from bibliographies. Patient characteristics, types of treatment, reconstruction, and outcome measures were collected. This review was not registered. Results: A total of 1969 unique English literature search results led to the inclusion of 118 studies. Further analysis was performed on 42 non-review articles, documenting a total of 772 patients. The mean patient age was 51.6 years, the mean BMI was 28, and there was a mean follow-up of 23.8 months. Discrete breast reconstruction data were given for 494 patients with 492 autologous reconstructions and 2 tissue expander-to-implant reconstructions. The most common reconstructive approach was a deep inferior epigastric flap. The most common VLNT donor site was the superficial inferior epigastric nodes, followed by superficial circumflex iliac nodes. Indications for 646 patients were for treatment and 18 were for prevention, while 108 were not specified. The mean excess volume reduction in treatment studies was 39.5%. A total of 168 complications (21.8%) were reported, with donor site seromas being the most common. Additionally, four partial and three total flap failures were reported. Conclusions: VLNT can be safely combined with autologous breast reconstruction for the treatment or prevention of breast cancer-related lymphedema. Future research should standardize the approach for data collection and report patient outcomes for lymphedema and immediate lymphatic reconstruction. Full article

This study aimed to evaluate the capacity of infrared thermography (IRT) to be used for the in situ clinical assessment of udder health status across lactation in goats. Two epidemiological studies were designed, with 106 purebred Skopelos goats being prospectively monitored over one lactation in the first study and 132 goats of the same breed from a second farm being enrolled in the second, cross-sectional study. Goats were categorized based on the clinical status of each udder half (healthy, fibrotic, both fibrotic and asymmetric, asymmetric, swollen supra-mammary lymph nodes, and abscessed). Skin surface temperature values of teats (TSST) and udder halves (USST), as well as temperature variations between different types of abscesses, based on the stage of their development (superficial developed, superficial fully mature, drained), and the symmetrical sites of the non-affected udder halves, were evaluated. Mixed linear regression analyses indicated that fibrosis, particularly when accompanied by asymmetry, resulted in a decrease of 0.2, 0.3, and 0.3 °C (p < 0.05) and of 0.6, 0.9, and 1.4 °C (p < 0.001) in the maximum, mean, and minimum USST, respectively. Recording season significantly affected USST and TSST (p < 0.001), with both of them increasing between February and August. Additionally, TSST appeared to be an unreliable indicator of udder health status, while abscesses exhibited distinct temperature patterns based on their developmental stage. It is concluded that IRT has the potential to be used on site for the detection of temperature alterations associated with chronic udder health issues, yet future studies on a larger and more diverse population of goats with various udder health conditions is needed to confirm its extensive applicability under real-world conditions. Full article

The highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) has caused huge economic losses to the pig industry in China. This study evaluated the damage to peripheral immune tissues in the early infection of HP-PRRSV, including the hilar lymph nodes, mandibulares lymph nodes, inguinales superficials lymph nodes, spleens, and tonsils. HP-PRRSV infection led to a reduction in CD4⁺ and CD8⁺ T cells, as well as CD19⁺ B cells, in the tonsils. Additionally, CD163⁺ macrophages and CD56⁺ NK cells increased in all peripheral lymphoid organs, with NK cells migrating toward the lymphoid follicles. However, no significant changes were observed in CD11c⁺ dendritic cells. RNA-seq analysis showed the down-regulation of T and B cell functions, while macrophage and NK cell functions were enhanced. Gene Ontology (GO) and KEGG pathway analysis indicated the up-regulation of necroptosis processes. Western blotting and immunofluorescence confirmed that HP-PRRSV induced PKR-mediated necroptosis in immunocytes. This study provides new insights into the effects of early HP-PRRSV infection on peripheral immune organs, highlighting dynamic shifts in immune cell populations, virus-induced immunosuppression, and the role of PKR-mediated necroptosis. These findings improve our understanding of the immunomodulation induced by PRRSV infection. Full article

Caseous lymphadenitis is an infectious disease that has a significant economic impact on sheep breeding. The objectives of this study were to evaluate the effect of season, animals’ age, sex, body score and shearing on the clinical incidence of caseous lymphadenitis, relapses and abscess location in sheep from Settat province, Morocco. In this longitudinal study, 274 clinically healthy sheep were recruited in six flocks among 1451 inspected sheep and followed during 12 months to cover four seasons. The animals involved in this study were assigned to different age categories at continuous recruitment from February to July 2021 (lambs younger than 6 months, young sheep between 6 and 24 months and old sheep more than 24 months) and to sex categories. Selected animals were clinically examined every 2 months to detect superficial abscesses by palpation of superficial lymph nodes. Information about the number of abscesses and their locations was recorded and analyzed in multivariable statistical models. The results showed that 185/274 (67.5%) of the monitored animals developed superficial CL abscesses. The risk ratio (RR) of superficial CL was significantly higher between April and September compared to between January and March (RR~4.4; p < 0.0001). No significant difference was found between October and December compared to between January and March (RR = 1.2; p = 0.64). Regarding the effect of age, the results revealed that the RR was significantly lower in old sheep compared to lambs (RR = 0.45, p < 0.0001). No significant difference was detected between lambs and young sheep (RR = 0.7, p = 0.07). The prevalence of caudally located abscesses (prefemoral and popliteal lymph nodes, as well as in testicles, scrotum and mammary glands) was significantly higher in old sheep than in lambs (20% versus 3%; odds ratio = 7.8, p = 0.02). The sex, body score and shearing since the last examination did not show any significant effect on CL incidence (p > 0.1). Abscess relapse was significantly lower in old sheep than in lambs (IRR = 0.4, p = 0.003). The highest clinical CL incidence was observed in young animals between April and September and was likely due to indoor intensive rearing management. To conclude, both season and age had significant effects on superficial CL incidence. Farmers, veterinarians and technicians should focus attention and preventive measures against CL on young animals during spring and summer. Full article

Background and Objectives: Lymphedema is a progressive, chronic condition. Traumatic damage to the lymphatics, removal of lymph nodes, and/or radiation are the major causes of fibrosis and a subsequent pathological cascade. Macrophages play a crucial role in wound healing, with M1 macrophages known for their pro-inflammatory effects and M2 macrophages recognized for their anti-inflammatory effects, including improved angiogenesis, lymph angiogenesis, and tissue healing. This study aims to assess the use of calcitriol to alter the M2/M1 macrophage balance, reduce tissue fibrosis in a lymphedema model, promote new micro-lymphatic vessel formation, and evaluate the benefits of active vitamin D. Material and Methods: Forty-five rats were randomly divided into three groups: control surgery (group A), surgery with preoperative–postoperative calcitriol (group B), and postoperative calcitriol (group C). One week after the surgical ablation a total dose of 20 Gy radiation therapy was administered to the operated groin region. Micro-computed tomography was used for limb volume calculation, fluorescence lymphatic imaging was used to assess the presence of lymphedema, and histopathological analyses were conducted to evaluate the M1/M2 macrophage ratio, fibrosis accumulation, and lymph angiogenesis. Results: The micro-computed tomography evaluation revealed that 75% of the rats of group A exhibited long-lasting lymphedema. In group B, the initial lymphedema ratio was the lowest, affecting only 25% of the rats. After ligating the main vessels, a linear lymphatic microvascular structure was observed in groups B and C. Group B had a significant increase in M2 macrophages and newly formed lymphatic vessels (p < 0.05). However, group A showed a significant elevation of M1 macrophages and collagen accumulation (p < 0.05) in the surgically treated hind limb. Conclusions: Both histological analyses and clinical results reported a relevant influence of calcitriol administration. Among all groups, the most favorable outcomes were seen in group B (prophylaxis group). Hence, calcitriol administration could play a crucial role in enhancing the migration of M2 macrophages to the damaged tissue. Such migration may contribute to lymphedema resolution either by enhancing the organization of superficial lymphatic vessels or resolving fibrosis, or with a combination of both these mechanisms. Full article

The diagnosis of occult inguinal lymph node metastasis in clinically node-negative invasive penile squamous cell carcinoma (PSCC) has remained a challenge, with substantial perioperative complications. The recent refinements in the technique of dynamic sentinel lymph node biopsy (DSLNB) demonstrated high diagnostic accuracy with considerably lower morbidity compared to conventional open modified/superficial inguinal lymph node dissection (ILND). Although DSLNB, if available, has been endorsed as the preferred method for nodal staging in patients with invasive PSCC and no palpable inguinal lymphadenopathy in the recent penile cancer guidelines, its utilization has been quite limited so far. Laparoscopic and robotic-assisted ILND have emerged as alternatives for nodal staging in this patient population and are shown to improve the rate of wound infections and postoperative pain. For management of nodal metastasis in patients with clinically palpable inguinal lymph nodes, minimally invasive ILND has shown promising results as well. Nonetheless, given the rarity of PSCC and the absence of prospective studies and clinical trials, nodal staging and treatment of nodal metastasis in clinical practice will likely continue to vary across the medical centers in the following years. In this review, we first summarize the evolution of DSLNB and minimally invasive ILND and discuss the advantages and drawbacks of each management strategy. We further discuss the remaining challenges and future perspectives in the management of inguinal lymph nodes in patients with PSCC. Full article

Dermatophytic pseudomycetoma (DPM) is a rarely reported invasive fungal infection of humans and animals, especially cats. This study aimed to identify dermatophytes, breed associations, and the frequency of extracutaneous (EC) involvement in feline DPM. Electronic records and formalin-fixed paraffin-embedded tissue (FFPET) from 32 suspected DPM cases in 30 cats were retrieved from a diagnostic laboratory between 2018 and 2024. To confirm DPM and molecular identity, DNA was extracted from FFPET for ITS2 sequencing, and immunohistochemistry was performed on PCR-negative cases. All cases were confirmed as DPM. Microsporum canis was the only dermatophyte identified. The sensitivity and specificity of ITS2 sequencing for M. canis identification in FFPET were 22/32 (68.8%) and 21/22 (95.5%), respectively. Exotic (36.7%) and Persian (23.3%) but not British breeds (26.3%) were over-represented compared to feline admissions at an affiliated veterinary hospital (8.5%, p < 0.001; 3%, p < 0.001; 21.6%, p = 0.817, respectively). Five cases (16.7%) had EC lesions; two had intra-abdominal masses; two had oral cavity masses, including one which extended into the cranial vault; and one had superficial cervical lymph node invasion. Exotic and Persian breeds are over-represented for DPM and M. canis is the primary cause. EC lesions of DPM may occur more commonly than previously thought. Full article

Specimens collected from dead pigs are a welfare-friendly and cost-effective active surveillance. This study aimed to evaluate the accuracy of different postmortem specimens from dead piglets for disease detection, using PRRSV as an example. Three farrow-to-wean farms undergoing PRRSV elimination were conveniently selected. Samples were collected at approximately 8- and 20-weeks post-outbreak. Postmortem specimens included nasal (NS), oral (OS), and rectal (RS) swabs, tongue-tip fluids (TTF), superficial inguinal lymph nodes (SIL), and intracardiac blood. These were tested individually for PRRSV by RT-PCR. Sensitivity, specificity, negative and positive predictive values, and agreement of postmortem specimens were calculated using intracardiac sera as the gold standard. OS and SIL had the best overall performance, with sensitivities of 94.6–100%, specificities of 83.9–85.1%, and negative predictive values of 97.3–100%. TTF had high sensitivity (92.2%) but low specificity (53.9%) and positive predictive value (48.3%). While challenges in meeting sampling targets due to variable pre-weaning mortality were noted, PRRS was detected in all postmortem specimens. OS and NS showed promising results for disease monitoring, though TTF, despite their sensitivity, had lower specificity, making them less suitable for individual infection assessment but useful for assessing environmental contamination. Full article

Skin malignant melanoma (MM) is one of the most frequent and aggressive neoplasia worldwide. Its associated high mortality rates are mostly due to its metastases, while diagnosis and treatment of MM in its early stages is of favorable prognostic. Even skin superficial MMs at incipient local stages can already present with lymph node invasion and distant metastases. Therefore, knowledge of the controllable risk factors and pathogenic mechanisms of MM development, spreading, and metastatic pattern, as well as early diagnosis, are essential to decrease the high mortality rates associated with cutaneous malignant melanoma. Genetic factors are incriminated, although lifetime-acquired genetic mutations appear to be even more frequently involved in the development of MM. Skin melanocytes divide only twice per year and have time to accumulate genetic mutations as a consequence of environmental aggressive factors, such as UV exposure. In the search for more promising therapies, matrix metalloproteinases have become of significant interest, such as MMP-1, MMP-2, MMP-9, and MMP-13, which have been linked to more aggressive forms of cancer and earlier metastases. Therefore, the development of specific synthetic inhibitors of MMP secretion or activity could represent a more promising and effective approach to the personalized treatment of MM patients. Full article

Warthin tumors (WTs) are the second most common salivary gland tumors, most commonly found in the tail of the parotid gland. The lymphoid components of a WT may also serve as a site for tumor-to-tumor metastasis. This report describes the metastasis of cutaneous squamous cell carcinoma (cSCC) from the preauricular region to a parotid WT. A 68-year-old male patient was admitted to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Cracow, Poland, with a two-year history of a growing, painless skin tumor of the right preauricular region. The patient was eligible for surgical treatment with elective neck dissection at the Va, III, II, I levels with parotidectomy and the excision of the cSCC. In the histopathological examination of the components of the surgical specimen beside the primary cutaneous squamous cell carcinoma (cSCC), a parotid WT was found; in the majority, it was occupied and destroyed by the metastatic cSCC and radically removed. After a tumor board consultation, due to the advanced stage (pT3N2b LVI2 PNI0 R0), with three intraparotid lymph node metastases and LVI2, the patient was authorized for postoperative radiotherapy. In conclusion, tumor-to-tumor metastasis is an extremely rare entity. Surgery is the standard of care for both WTs and head and neck cSCC. In most cases, metastasis into the parotid gland can be successfully treated with superficial parotidectomy with facial nerve preservation. Dissemination into the parotid gland requires elective neck dissection, as well as adjuvant treatment. Full article

Diagnosing cutaneous melanomas relies mainly on histopathological analysis, which, in selected cases, can be aided by immunohistochemical evaluation of conventional melanocytic markers. Nevertheless, these malignancies, particularly in metastatic settings, may display divergent differentiation with unusual histological and immunohistochemical features. In this context, we present the case of a 65-year-old male diagnosed with typical superficial spreading melanoma who developed recurrence and metastatic lesions featuring angiosarcomatous differentiation. The diagnosis of the initial tumour and the subsequently dedifferentiated lesions was confirmed by ample immunohistochemical analysis, which included several melanocytic markers, as well as mesenchymal and vascular markers. The recurrent tumour and lymph nodes metastases were completely negative for Melan-A and PRAME, and focally positive for SOX10. Additionally, they also displayed diffuse, intense positivity for CD10 and WT1 and focal positivity for CD99, ERB, and CD31. Thus, the diagnosis of primary cutaneous melanoma with recurrent and metastatic divergent angiosarcomatous differentiation was established. This occurrence is particularly rare and can pose important diagnostic challenges. Therefore, in addition to presenting this highly unusual case, we also performed a comprehensive review of the literature on divergent differentiation in melanomas. Full article