UNASSIGNED: Primary malignancies of the cervical lymph nodes with special pathological characteristics are relatively uncommon in clinical settings, and there have been few reports on these tumors. The precise basis for their pathogenesis is poorly understood, and their diagnosis can be challenging. In addition, no clinically validated treatments have been established to date for affected patients.
UNASSIGNED: Here, we describe a case of a 65-year-old male patient who exhibited the enlargement of several lateral and supraclavicular lymph nodes on the right side of his neck that presented as a large mass associated with a high fever and benign leukocytosis. He did not exhibit any relevant prior history. Radiological assessment revealed that this lesion was the primary tumor and that it has since spread to the liver. Histological assessment was unable to definitively classify the pathological characteristics of this tumor. Without any relevant morphological findings, immunohistochemical outcomes were not sufficiently specific to clarify the origin of these cells. When distinguishing it from similar sarcomas of the lymphohematopoietic system, it was found to not be typical of a histiocytic or dendritic cell tumor. Treatment to this patient was performed following multidisciplinary consultation and consisted of one course of a cyclophosphamide plus doxorubicin, vincristine, and dexamethasone regimen and two courses of the cyclophosphamide plus pirarubicin, vincristine, and dexamethasone regimen. However, the tumor exhibited minimal response to such treatment. While radiotherapy was proposed, the patient lacked confidence in the approach and declined treatment. He eventually developed severe tumor-associated complications. In the discussion section of this report, we detail and analyze the pathogenesis, diagnosis, and referential treatments of this rare malignancy.
UNASSIGNED: This is the first report describing such a malignancy, and we hope that the publication of these findings can lead to the recognition of this tumor while supporting efforts to acquire greater experience in the diagnosis and treatment of affected patients.

BACKGROUND: Owing to the advancement in bacterial identification techniques, the detection rate of non-tuberculous mycobacterium (NTM) has been on the rise. Different from Mycobacterium tuberculosis, the clinical symptoms of NTM are not easily detected, and the clinical efficacy and prognosis are somewhat heterogeneous. To report a case of Mycobacterium gordoniasis of cervical lymph node diagnosed in Anhui Chest Hospital in July 2022.
METHODS: Upon examination, the patient who weighed 67.5 kg, was human immunodeficiency virus negative, healthy, without hypertension, diabetes, heart disease and other basic diseases microscopic analysis revealed granulomatous inflammation with coagulation necrosis in the lymphocyte, and tuberculosis was not ruled out. Plain computed tomography scans of the neck and chest indicated the presence of a single grayish-yellow and grayish-brown tissue, the dimensions of which was top of form 10.5 cm × 3.0 cm × 1.5 cm. After pathological consultation in our hospital, the diagnosis was confirmed as NTM infection.
CONCLUSIONS: This case report and the clinical epidemiological research on improving NTM have important guiding significance for improving decision-making in clinical treatments.

Cervical lymph node metastasis is an important determinant of cancer stage and the selection of an appropriate treatment plan for patients with head and neck cancer. Therefore, metastatic cervical lymph nodes should be effectively differentiated from lymphoma, tuberculous lymphadenitis, and other benign lymphadenopathies. The aim of this work is to describe the performance of Doppler ultrasound and superb microvascular imaging (SMI) in evaluating blood flow information of cervical lymph nodes. In addition, the features of flow imaging in metastatic lymph nodes, lymphoma, and tuberculous lymphadenitis were described. Compared with Doppler ultrasound, SMI, the latest blood flow imaging technology, could detect more blood flow signals because the sensitivity, specificity, and accuracy of SMI in the diagnosis of cervical lymph node disease were higher. This article summarizes the value of Doppler ultrasound and SMI in evaluating cervical lymph node diseases and focuses on the diagnostic performance of SMI.

BACKGROUND: This study aimed to compare the diagnostic value of [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT imaging for primary lesions and metastatic lymph nodes in patients with tonsil cancer.
METHODS: Twenty-one tonsil cancer patients who underwent [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT scans within two weeks in our centre were retrospectively enrolled. The maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of the two tracers were compared by using the Mann‒Whitney U test. In addition, the sensitivity, specificity, and accuracy of the two methods for diagnosing metastatic lymph nodes were analysed.
RESULTS: In detecting primary lesions, the efficiency was higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (20/22) than for [18F]FDG PET/CT (9/22). Although [68 Ga]Ga-DOTA-FAPI-04 uptake (SUVmax, 5.03 ± 4.06) was lower than [18F]FDG uptake (SUVmax, 7.90 ± 4.84, P = 0.006), [68 Ga]Ga-DOTA-FAPI-04 improved the distinction between the primary tumor and contralateral normal tonsillar tissue. The TBR was significantly higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (3.19 ± 2.06) than for [18F]FDG PET/CT (1.89 ± 1.80) (p < 0.001). In lymph node analysis, SUVmax and TBR were not significantly different between [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT (7.67 ± 5.88 vs. 8.36 ± 6.15, P = 0.498 and 5.56 ± 4.02 vs. 4.26 ± 3.16, P = 0.123, respectively). The specificity and accuracy of [68 Ga]Ga-DOTA-FAPI-04 PET/CT were higher than those of [18F]FDG PET/CT in diagnosing metastatic cervical lymph nodes (all P < 0.05).
CONCLUSIONS: The availability of [68 Ga]Ga-DOTA-FAPI-04 complements the diagnostic results of [18F]FDG by improving the detection rate of primary lesions and the diagnostic accuracy of cervical metastatic lymph nodes in tonsil cancer compared to [18F]FDG.

UNASSIGNED: To investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes.
UNASSIGNED: A retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS.
UNASSIGNED: Of the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p< 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p< 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p<0.001).
UNASSIGNED: In this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.

OBJECTIVE: Dynamic 18F-FDG PET-CT scanning can accurately quantify 18F-FDG uptake and has been successfully applied in diagnosing and evaluating therapeutic effects in various malignant tumors. There is no conclusion as to whether it can accurately distinguish benign and malignant lymph nodes in nasopharyngeal cancer. The main purpose of this study is to reveal the diagnostic value of dynamic PET-CT in cervical lymph node metastasis of nasopharyngeal cancer through analysis.
METHODS: We first searched for cervical lymph nodes interested in static PET-CT, measured their SUV-Max values, and found the corresponding lymph nodes in magnetic resonance images before and after treatment. The valid or invalid groups were included according to the changes in lymph node size before and after treatment. If the change in the product of the maximum diameter and maximum vertical transverse diameter of the lymph node before and after treatment was greater than or equal to 50%, they would be included in the valid group. If the change was less than 50%, they would be included in the invalid group. Their Ki values were measured on dynamic PET-CT and compared under different conditions. Then, we conducted a correlation analysis between various factors and Ki values. Finally, diagnostic tests were conducted to compare the sensitivity and specificity of Ki and SUV-Max.
RESULTS: We included 67 cervical lymph nodes from different regions of 51 nasopharyngeal cancer patients and divided them into valid and invalid groups based on changes before treatment. The valid group included 50 lymph nodes, while the invalid group included 17. There wer significant differences (p < 0.001) between the valid and the invalid groups in SUV-Max, Ki-Mean, and Ki-Max values. When the SUV-Max was ≤4.5, there was no significant difference in the Ki-Mean and Ki-Max between the two groups (p > 0.05). When the SUV-Max was ≤4.5 and pre-treatment lymph nodes were <1.0 cm, the valid group had significantly higher Ki-Mean (0.00910) and Ki-Maximum (0.01004) values than the invalid group (Ki-Mean = 0.00716, Ki-Max = 0.00767) (p < 0.05). When the SUV-Max was ≤4.5, the pre-treatment lymph nodes < 1.0 cm, and the EBV DNA replication normal, Ki-Mean (0.01060) and Ki-Max (0.01149) in the valid group were still significantly higher than the invalid group (Ki-Mean = 0.00670, Ki-Max = 0.00719) (p < 0.05). The correlation analysis between different factors (SUV-Max, T-stage, normal EB virus DNA replication, age, and pre-treatment lymph node < 1.0 cm) and the Ki value showed that SUV-Max and a pre-treatment lymph node < 1.0 cm were related to Ki-Mean and Ki-Max. Diagnostic testing was conducted; the AUC value of the SUV-Max value was 0.8259 (95% confidence interval: 0.7296-0.9222), the AUC value of the Ki-Mean was 0.8759 (95% confidence interval: 0.7950-0.9567), and the AUC value of the Ki-Max was 0.8859 (95% confidence interval: 0.8089-0.9629). After comparison, it was found that there was no significant difference in AUC values between Ki-Mean and SUV-Max (p = 0.220 > 0.05), and there was also no significant difference in AUC values between Ki max and SUV-Max (p = 0.159 > 0.05). By calculating the Youden index, we identified the optimal cut-off value. It was found that the sensitivity of SUV-Max was 100% and the specificity was 66%, the sensitivity of Ki-Mean was 100% and the specificity was 70%, and the sensitivity of Ki-Max was 100% and the specificity was 72%. After Chi-Square analysis, it was found that there was no significant difference in specificity between Ki-Mean and SUV-Max (p = 0.712), and there was also no significant difference in specificity between Ki-Max and SUV-Max (p = 0.755).
CONCLUSIONS: Dynamic PET-CT has shown a significant diagnostic value in diagnosing cervical lymph node metastasis of nasopharyngeal cancer, especially for the small SUV value, and lymph nodes do not meet the metastasis criteria before treatment, and EBV DNA replication is normal. Although the diagnostic accuracy, sensitivity, and specificity of dynamic PET-CT were not significantly different from traditional static PET-CT, the dynamic PET-CT had a more accurate tendency.

UNASSIGNED: To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy.
UNASSIGNED: A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups.
UNASSIGNED: The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023).
UNASSIGNED: No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate.

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.

To identify efficacy and prognosis of radiotherapy (RT) for cervical lymph node recurrence (CLNR) in thoracic esophageal squamous cell carcinoma (TESCC) after curative resection. The clinical data from 65 patients were retrospectively analyzed. The Kaplan-Meier method was employed to analyze the survival of patients. The Cox proportional hazards model was then exploited for multivariate analysis. The median overall survival (OS) was 20 months; one-year, two-year, three-year and five-year survival rates were 68.3%, 47.3%, 33.4% and 10.6%. The median progression-free survival (PFS) was 14 months. Univariate analysis indicated that time from surgery to recurrence, number of recurrent lymph nodes and dose of RT were significant prognostic factors, whereas multivariate analysis showed that number of recurrent lymph nodes and radiation dose were independent factors. RT was an effective salvage treatment for patients with CLNR after surgery. Those patients who showed single lymph node recurrence and who were exposed to ≥60 Gy of RT experienced a favorable prognosis.

OBJECTIVE: The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency.
METHODS: The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1 year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency.
RESULTS: The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results.
CONCLUSIONS: Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.