Sarcoidosis Presenting as Late Seroma Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma.

ABSTRACT: Late seroma related to breast silicone implants is a rare complication. Interest for its characterization has grown after its association with the recently described breast implant-associated anaplastic large cell lymphoma. The differential diagnosis includes infectious diseases, mechanical and traumatic causes, tumors, postpartum seroma, and inflammatory, allergic, or idiopathic causes.Sarcoidosis has been associated with breast silicone implants over the last decades, but it has never been reported as a cause of breast effusion. We describe a rare presentation of sarcoidosis as a late breast implant seroma simulating the clinical features and radiologic findings of breast implant-associated anaplastic large cell lymphoma and highlight that sarcoidosis can be suspected by the presence of nonnecrotizing epithelioid granulomas in the cytology, with a characteristic inverted ratio of CD4/CD8 T cells.The aims of this article are to review the current evidence about sarcoidosis related to silicone implants and breast cancer, provide a new alternative in the differential diagnosis of late seroma, and advise the scientific community how early implant removal can improve the disease.

NUT midline carcinomas and their differentials by a single molecular profiling method: a new promising diagnostic strategy illustrated by a case report.

NUT midline carcinoma is an aggressive neoplasm defined by chromosomal rearrangements of the nuclear protein in testis (NUT) gene (NUTM1). In this article, we present a strategy to detect this rare tumor through a standard DNA methylation array analysis even when occurring in unusual anatomic sites. We illustrate our approach through a case study in which we detected metastatic spread of a NUT midline carcinoma within a bone marrow biopsy that exhibited histological features of a blastoid, undifferentiated neoplasm. Our strategy builds on molecular data derived from The Cancer Genome Atlas and Gene Expression Omnibus as well as computational strategies adopted from the Brain Tumor Methylation Classifier. It is a combined approach that detects the unusual cell lineage of NUT midline carcinomas and makes diagnostic use of the entity-specific copy number alterations.

[Reactive Lymphadenopathies]. / Nicht-neoplastische Erkrankungen des Lymphknotens: vom histologischen Muster zur Diagnose.

Reactive Lymphadenopathies Abstract. A lymphadenopathy, i. e. lymph node enlargement, is a relatively frequent finding in both children and adults and in the vast majority of cases corresponds to reactive changes that disappear spontaneously within several weeks. In cases with a marked or persistent enlargement of the lymph node or an unusual clinical presentation, further investigation is warranted, which relies, in addition to clinical, laboratory and radiological findings, upon the histological examination of the enlarged lymph node - being the crucial task thereof the discrimination between malignant and benign processes. The capital importance of this is illustrated by the fact that reactive lymphadenopathies mistaken for lymphomas are among the most frequently misdiagnosed types of cancer. On the other hand, the recognition of more or less specific histopathological patterns of reactive changes serves to narrow down the various potential causes, including those that would otherwise only be recognised by the use of resource-intensive ancillary techniques. Hence, the narrower the differential diagnosis based on the histopathological examination is, the more targeted and efficient the application of these techniques can be. This review provides a summary of the essential histopathological features of some of the most common and best-characterised reactive lymphadenopathies. After a description of the most important morphological patterns of lymph node changes, we will discuss individual clinical pictures, from infectious and idiopathic processes to autoimmune diseases and drug-associated changes.

Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial.

BACKGROUND: The objective of this study was to evaluate and compare the safety and effectiveness of four different dermal fillers in the treatment of facial lipoatrophy secondary to human immunodeficiency virus. METHODS: The authors conducted a clinical trial including 147 patients suffering from human immunodeficiency virus-induced lipoatrophy treated with Sculptra (poly-L-lactic acid), Radiesse (calcium hydroxylapatite), Aquamid (polyacrylamide), or autologous fat. Objective and subjective changes were evaluated during a 24-month follow-up. Number of sessions, total volume injected, and overall costs of treatment were also analyzed. A comparative cost-effectiveness analysis of the treatment options was performed. RESULTS: Objective improvement in facial lipoatrophy, assessed by the surgeon in terms of changes from baseline using the published classification of Fontdevila, was reported in 53 percent of the cases. Patient self-evaluation showed a general improvement after the use of facial fillers. Patients reported being satisfied with the treatment and with the reduced impact of lipodystrophy on their quality of life. Despite the nonsignificant differences observed in the number of sessions and volume, autologous fat showed significantly lower costs than all synthetic fillers (p < 0.05). CONCLUSIONS: Surgical treatment of human immunodeficiency virus-associated facial lipoatrophy using dermal fillers is a safe and effective procedure that improves the aesthetic appearance and the quality of life of patients. Permanent fillers and autologous fat achieve the most consistent results over time, with lipofilling being the most cost-effective procedure.

A model for predicting mortality among critically ill burn victims.

OBJECTIVE: To develop a model for predicting mortality among burn victims. METHODS: All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. RESULTS: Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality. CONCLUSIONS: We propose a mortality predictive equation for burned victims. In this model, MV and not inhalation injury is a mortality risk factor.

Organ dysfunction as estimated by the sequential organ failure assessment score is related to outcome in critically ill burn patients.

The objectives of the study were to assess organ dysfunction in burn patients by using the Sequential Organ Failure Assessment (SOFA) score, to determine the relationship between early (day 1) and late (day 4) organ dysfunction, as well as the change in organ dysfunction from admission to day 4, and mortality. The design was a prospective observational cohort study. Patients were admitted to our intensive care burn unit with severe thermal burns (> or =20% total body surface area [BSA] burned) or inhalation injury with a delay from injury to admission less than 12 h and a length of stay less than 3 days (n = 439; age, 46.0 +/- 20.3 yrs; total BSA burned, 31.6% +/- 20.2% [mean +/- SD]; inhalation injury, 44.4%; crude mortality, 18.5%). Sequential Organ Failure Assessment scores were measured on admission (SOFA 0) and on subsequent days (SOFA 1, SOFA 2, SOFA 3, and SOFA 4). The difference between SOFA 0 and SOFA 4 (DeltaSOFA 0-4) was calculated. Multivariate logistic regression analyses, including other variables associated with mortality in the models, were performed to calculate adjusted odds ratios (ORs) of organ dysfunction measurements for mortality. After adjusting for age, BSA burned, diagnosis of inhalation injury, and sex, SOFA 1 (OR, 1.89; 95% confidence interval [CI], 1.55-2.32), SOFA 4 (OR, 1.33; 95% CI, 1.19-1.47), and DeltaSOFA 0-4 (OR, 1.40; 95% CI, 1.28-1.55) were independently associated with mortality. The SOFA score is useful to assess organ dysfunction in burn patients. Burn-induced organ dysfunction (early and late), as well as the change in organ dysfunction, is independently associated with mortality.