Spitz melanocytic neoplasms with MLPH::ALK fusions: Report of two cases with previously unreported features and literature review.

ALK-fused Spitz melanocytic neoplasms are a distinct subgroup of melanocytic lesions exhibiting unique histopathologic characteristics. These lesions often manifest as exophytic or polypoid tumors, characterized by fusiform-to-epithelioid melanocytes arranged in a nested, fascicular, or plexiform growth pattern. Several fusion partners of the ALK gene have been identified in spitzoid melanocytic neoplasms, with TPM3 and DCTN1 being the most prevalent. Less common fusion partners include NPM1, TPR, CLIP1, GTF3C2, EEF2, MYO5A, KANK1, and EHBP1. The MLPH gene, which encodes melanophilin (MLPH), playing a crucial role in regulating skin pigmentation by acting as a linker between RAB27A and myosin Va during melanosome transport, has also recently been recognized as a rare fusion partner of ALK in Spitz melanocytic neoplasms. Currently, there exists a sparse documentation within English literature, illustrating a limited number of cases featuring MLPH::ALK fusion in Spitz melanocytic neoplasms. In this report, we present two additional cases, including a previously unreported instance of Spitz melanoma, contributing to the expanding knowledge on ALK-fused Spitz melanocytic neoplasms. In addition, we provide a comprehensive review of the clinical, histopathologic, and molecular features observed in documented cases with this novel fusion.

Nectin-4 expression in a subset of cutaneous adnexal carcinomas: A potential target for therapy with enfortumab vedotin.

BACKGROUND: Enfortumab vedotin (EV) is an antibody-drug conjugate directed against Nectin-4 that is used to treat urothelial carcinoma. Nectin-4 is inherently expressed in the skin and adnexal structures. Since therapeutic options for cutaneous adnexal carcinomas are limited, we sought to evaluate Nectin-4 expression in adnexal carcinomas and benign adnexal neoplasms to identify tumors that are potentially targetable with EV. METHODS: Eight sebaceous carcinomas (seven periocular and one lymph node metastasis), eight digital papillary adenocarcinomas, seven squamoid eccrine ductal carcinomas, eight poromas, eight trichilemmomas, and seven sebaceous adenomas were subjected to immunohistochemical staining for anti-Nectin-4 antibody. H-scores for Nectin-4 expression were calculated. RESULTS: Benign adnexal neoplasms had a significantly lower mean (±SD) Nectin-4 H-score (142.6 ± 39.1) than did the adnexal carcinomas (198 ± 90.8; p = 0.006). Nectin-4 was expressed in 91% (21/23) of adnexal carcinomas. Sebaceous carcinomas frequently exhibited high expression of Nectin-4 (88% [7/8]), with a mean (±SD) H-score (258.1 ± 58.4) significantly higher than those for digital papillary adenocarcinomas (197.5 ± 52.5; p = 0.035) and squamoid eccrine ductal carcinomas (131.4 ± 114.1; p = 0.031). Sebaceous carcinomas also had significantly higher H-scores than did sebaceous adenomas (186.4 ± 25.0; p = 0.013). CONCLUSIONS: Increased Nectin-4 expression in a subset of cutaneous adnexal carcinomas, particularly sebaceous carcinomas, reveals that EV is a potential therapeutic option for these tumors.

Spitz Melanoma With SLC20A1::ALK Fusion: A Novel Fusion Previously Undescribed in Spitz Melanocytic Neoplasm.

ABSTRACT: Spitz melanocytic neoplasms exhibit frequent chromosomal rearrangements leading to recurring gene fusions, such as ALK fusions. TPM3 and DCTN1 emerge as the predominant fusion partners of ALK, although less common partners such as NPM1, TPR, CLIP1, GTF3C2, MLPH, EEF2, MYO5A, and KANK1 have also been documented. Although ALK fusions are primarily associated with Spitz nevi or atypical Spitz tumors, instances of Spitz melanoma with ALK fusions documented in the English literature are exceedingly rare. Here, we present a case of Spitz melanoma harboring SLC20A1::ALK fusion, highlighting a novel fusion transcript not previously reported in Spitz melanocytic neoplasms, including Spitz melanomas. In addition, the tumor exhibits multiple aberrant chromosomal alterations characteristic of melanoma, along with a somatic mutation in GRM3.

Pigmented Villonodular Synovitis: A Metastatic Melanoma Imitator.

ABSTRACT: A 45-year-old woman with a history of previously treated left plantar foot melanoma presented with a left thigh mass. Fine needle aspiration findings were concerning for metastatic melanoma (MM). Imaging was remarkable for PET-avidity of both the biopsied thigh mass and of a left posterior knee nodule. The knee nodule was also enhancing on MRI, concerning for a site of metastasis. Resection of the thigh mass and intra-articular nodule was performed. The thigh lesion was positive for MM. The specimen obtained from the knee demonstrated a proliferation of spindle and epithelioid cells associated with focal fibrosis and scattered giant cells with brown pigment, raising the possibility of melanoma metastasis with treatment effect. Additional immunohistochemical studies with anti-SOX10 failed to demonstrate melanoma cells in the lesion. The final diagnosis for the knee nodule was pigmented villonodular synovitis. This case highlights the potential for pigmented villonodular synovitis to mimic MM, requiring additional pathologic analysis to yield an accurate diagnosis.

Continued Positive Job Search Experience for New Pathologists Seeking First Employment During the COVID-19 Pandemic (2020-2022).

CONTEXT.­: As pathologists retire and leave the field, it is critical to accurately capture employment trends for new-in-practice pathologists. There is always interest in the job market for newly graduated pathology trainees and prospective pathology trainees, but it is unclear how the COVID-19 pandemic may have affected the job search experience. OBJECTIVE.­: To provide an update on trends gleaned from a survey of pathology graduates' job search experiences during the COVID-19 pandemic. DESIGN.­: We analyzed data from an annual job search survey sent by the College of American Pathologists Graduate Medical Education Committee between 2020 and 2022 to College of American Pathologists junior members and fellows in practice 3 years or less actively looking for a nonfellowship position. Various indicators of the job search experience were compared year to year and with the data previously published 2017 to 2019 and 2012 to 2016. RESULTS.­: Analysis revealed continued positive trends between the 2020 to 2022 data and the data from 2017 to 2019 and 2012 to 2016. This includes continued ease in finding positions, continued availability of jobs in the subspecialty of choice, continued satisfaction with the positions accepted, and, notably, higher starting salaries. CONCLUSIONS.­: Despite the many challenges of the COVID-19 pandemic, job market trends for newly graduated pathology trainees continue to be favorable with respect to multiple indicators compared with 2 prior periods, 2017 to 2019 and 2012 to 2016.

TRPS1 expression in non-melanocytic cutaneous neoplasms: an immunohistochemical analysis of 200 cases.

BACKGROUND: Although trichorhinophalangeal syndrome type 1 (TRPS1) was initially thought to be highly sensitive and specific for carcinomas and mesenchymal tumors of mammary origin, more recent data suggest its expression is not limited to breast neoplasms but also can be seen in other cutaneous neoplasms, such as extramammary Paget disease and squamous cell carcinoma (SCC) in situ. METHODS: Two-hundred cases of non-melanocytic cutaneous neoplasm, including basal cell carcinomas (BCCs) (n = 41), SCCs (n = 35), Merkel cell carcinomas (MCCs) (n = 25), and adnexal neoplasms (n = 99), were tested for TRPS1 expression using a monoclonal anti- TRPS1 rabbit anti-human antibody. RESULTS: TRPS1 expression was present in almost all cases of SCC (94%), with a median H-score of 200, while it was either absent or only focally present in most BCCs (90%), with a median H-score of 5. The difference between BCCs and SCCs in H-score was significant (p < .001). All MCCs (100%) lacked TRPS1 expression. TRPS1 expression was frequently seen in most adnexal neoplasms, benign and malignant, in variable intensity and proportion but was consistently absent in apocrine carcinomas. All endocrine mucin-producing sweat gland carcinomas (EMPSGCs) (100%, 6/6) showed diffuse and strong TRPS1 immunoreactivity, with a median H-score of 300, which was significantly different (p < .001) than that of BCCs. CONCLUSIONS: Our study shows that TRPS1 may be an effective discriminatory marker for BCCs and SCCs. It also has a role in distinguishing BCCs from EMPSGCs.

Leadership perspectives on osteopathic medical school applicants to pathology residency training.

The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.

Keratosis Pilaris-Like Reaction Associated With Chromatin Remodeling Complex Inhibition in Uveal Melanoma.

This case series describes a constellation of novel adverse reactions in 3 of 9 patients with uveal melanoma receiving treatment targeting activity of the Brahma-associated factor chromatin remodeling complex.

Economic impact of vaccination with PCV13 vs. vaccination with PCV 10 in Colombia / Impacto económico de la vacunación con PCV13 frente al PCV 10 en Colombia

We aim was to estimate the difference of costs and expected cases from serotype coverage of the 13-valent pneumococcal conjugated vaccine (PCV13) and 10-valent pneumococcal conjugated vaccine (PCV10) in the population under 5 years of age in Colombia, using a deterministic model. We considered the probabilities of incidence, mortality and sequelae from infections of pneumonia, meningitis, sepsis and acute otitis media, as well as the clinical effectiveness of PCV13 and PCV10, which were determined by a systematic review of the literature. A2 + 1 immunization schedule was considered, and a 42% herd effect and 84.09% population coverage were assumed. The perspective was the Colombian health system with a time horizon of 5-years. The model showed greater protection of PCV13 in comparison to PCV10. A difference of 98 prevented deaths was observed for meningitis, pneu monia and sepsis. The opportunity cost difference found in the 5-year follow-up between PCV13 and PCV10 vaccines was COP (Colombian pesos) 36,128,082,380 at 2012 prices, which represents COP 7,225,616,476 of difference per year. PCV13 is considered the better alternative, this is mainly due to the impact that this vaccine has on the disease burden of the infections produced by Streptococcus pneumoniae in Colombian children under five years of age.

Nuestro objetivo fue estimar la diferencia de los costos y los casos que se esperan de la cobertura de serotipos de la vacunas conjugadas 13-valente neumocócica (PCV13) y 10-valente neumocócica (PCV10), en la población menor de cinco años de edad en Colombia, mediante un modelo determinista. Se consideraron las probabilidades de incidencia, mortalidad y secuelas de las infecciones de neumonía, meningitis, sepsis y la otitis media aguda, así como la efectividad clínica de la PCV13 y la PCV10, que se determinaron mediante una revisión sistemática de la literatura. Se consideró un esquema de vacunación A2 + 1 y se supuso un efecto grupal del 42% y una cobertura de la población de 84,09%. La perspectiva fue el sistema de salud colombiano, con un horizonte temporal de cinco años. El modelo mostró una mayor protección de PCV13 en comparación con PCV10. Se observó una diferencia de 98 muertes que se evitaron por causa de la meningitis, la neumonía y la sepsis. La diferencia costooportunidad encontrada en el seguimiento de cinco años entre las vacunas PCV13 y la PCV10 fue de 36,128,082,380 pesos colombianos (COP) a precios de 2012, lo que representa una diferencia de COP 7,225,616,476 por año.

Costo-efectividad de linezolid comparado con vancomicina en el manejo de la neumonía asociada a ventilación mecánica en Colombia / Cost effectiveness of linezolid compared with vancomycin in the management of ventilator-associated pneumonia in Colombia

Objetivo: Estimar la costo-efectividad de linezolid versus vancomicina en el manejo de neumonía asociada a ventilación mecánica (NAV) causada por Staphylococcus aureus resistente a meticilina (SARM) en Colombia. Materiales y métodos: Se construyó un árbol de decisión para determinar la razón de costo-efectividad incremental de linezolid (600 mg iv/12 h) comparado con vancomicina (15 mg/kg iv/12 h) en el tratamiento de NAV por SARM. La perspectiva fue la del sistema de salud incluyendo solo costos directos. Todas las unidades monetarias se expresan en pesos colombianos del 2013 sin descuento (1 USD =$ 1.876,22). Se empleó un horizonte temporal de 30 días. Los resultados se midieron en proporción de pacientes curados. Los datos de eficacia y seguridad se tomaron de la literatura. Los costos de los procedimientos se obtuvieron del manual tarifario ISS del 2001, para medicamentos se utilizó el SISMED y la regulación de precios vigente. Se realizaron análisis de sensibilidad univariados y probabilísticos. Resultados: Los costos totales esperados por paciente curado fueron: $ 2.600.094 para linezolid y $ 1.992.753 para vancomicina. La proporción de pacientes curados fue: 53% con linezolid y 41%.con vancomicina. La razón de costo-efectividad de linezolid comparado con vancomicina fue $ 5.061.173 por paciente curado. Para cada alternativa, los resultados fueron sensibles a la probabilidad de éxito del tratamiento, a la probabilidad de presentar eventos adversos y al costo del tratamiento. Conclusión: En Colombia, linezolid sería una alternativa costo-efectiva en el tratamiento de NAV por SARM, para disponibilidades a pagar superiores a $ 5.061.173 por paciente curado.

Objective: To estimate the cost-effectiveness of linezolid versus vancomycin in the management of ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in Colombia. Materials and methods: We constructed a decision tree to determine the incremental cost effectiveness ratio (ICER) of linezolid (600 mg iv /12 h) compared to vancomycin (15 mg/kg iv/12 h) for the treatment of VAP caused for MRSA. The perspective is that of the Colombian health system, including only direct costs. All currency units are in Colombian pesos (COP, 2013) with no discount. (1 USD = $1,876.22). We used a time horizon of 30 days. The results were measured in the proportion of patients cured. The efficacy and safety data were taken from the literature. The costs of procedures were obtained of ISS tariff manual of 2001 and for drugs current price regulations and the SISMED database were used. Univariate and probabilistic sensitivity analyses were performed. Results: The total costs expected per patient cured were COP 2,600,094 for linezolid and COP 1,992,753 for vancomycin. The proportion of cured patients was 53% with linezolid and 41% with vancomycin. The ICER of linezolid compared with vancomycin was COP 5,061,173 per patient cured. For each alternative, the results were sensitive to the probability of the success of treatment, the probability of adverse events and the cost of treatment. Conclusion: Linezolid would be a cost-effective alternative in the treatment of VAP for MRSA in Colombia for willingness to pay above COP 5,061,173 per patient cured.

Tuberculosis pulmonar y lingual. Presentación de un caso / A Case Report of Pulmonary and Lingual Tuberculosis

Objetivo: presentar un caso raro de tuberculosis (TB) lingual secundaria, el cual constituye el primero reportado en el hospital y en la provincia en 50 años. Caso clínico: paciente masculino de 69 años de edad con antecedentes de dos hospitalizaciones por neumonía bacteriana adquirida en la comunidad, que es ingresado debido a que desde hace 3 semanas presenta fiebre, tos seca irritativa y síntomas constitucionales acompañados de lesiones nodulares de 0,5-1 cm en el dorso de la lengua y aftas dolorosas en la base de la misma, especialmente a la palpación, que le impedían alimentarse. El estudio BAAR del esputo reporta codificación 9 en 2 oportunidades; la prueba de tuberculina, los exámenes radiológicos y la histología confirman el diagnóstico. Se aplica terapéutica antituberculosa y a los 2 meses se aprecia desaparición de los nódulos, manteniéndose asintomático en el seguimiento en consulta externa. Conclusiones: la TB de la lengua es un hallazgo infrecuente que debe ser incluido en el diagnóstico diferencial de las patologías de la cavidad oral. Este caso demuestra la importancia de mantener la alerta sobre esta entidad en la práctica médica y odontológica.

Objective: The objective of this study is to present a rare case of secondary lingual tuberculosis (TB). This was the first reported occurrence of this disease in the hospital and in the province in 50 years. Case report: A 69 year old male patient who had been hospitalized twice because of bacterial pneumonia acquired in the community was admitted to the hospital. For three weeks prior to admission the patient had suffered fever, dry irritating coughing, constitutional symptoms, 0.5 to 1.0 cm nodular lesions on the dorsum of the tongue, and canker sores at the base of the tongue. As a result the patient had been unable to eat. Two acid fast bacilli (AFB) smears both showed a rating of 9. Tuberculosis testing, x-rays and histology confirmed the diagnosis. Tuberculosis treatment was begun. After two months the nodules disappeared. The patient remained asymptomatic and continues to be monitored on an outpatient basis. Conclusions: TB of the tongue is a rare finding that should be included in the differential diagnosis of diseases of the oral cavity. This case demonstrates the importance of continued vigilance of this entity in medical and dental practice.

Xantelasma gástrico y Helicobacter pylori. Reporte de un caso y revisión de la literatura / Gastric Xanthelasma and Helicobacter Pylori. A Case Report and a Literature Review

Se presenta el caso de una paciente de 40 años con xantelasma gástrico asociado a Helicobacter pylori, asociación infrecuente en la literatura médica. Se resalta la rareza de esta entidad, las manifestaciones clínicas, el diagnóstico, la terapéutica y la importancia de su relación con Helicobacter pylori. Se realizó una revisión de los aspectos más importantes de estos aspectos. Se concluye que el Helicobacter pylori debe tenerse presente por su carácter de agente etiológico en enfermedades malignas y que deben agotarse todos los medios para su oportuna identificación.

The case of a 40 years old patient diagnosed with gastric Xanthelasma related to Helicobacter pylori is presented. This association is rare to find in medical literature. The following aspects are highlighted: entity rareness, clinical manifestations, diagnosis, treatment and importance of the association with Helicobacter pylori. A literature review on the most important features of these processes has been carried out. It has been concluded that Helicobacter pylori should be seriously taken into consideration because of its aetiology in malignant diseases and that all kinds of investigations should be performed in order to diagnose it in due time.

Síndrome poliglandular autoinmune tipo II: presentación de un caso / Polyglandular autoimmune syndrome type II: a case report

Fundamento: la afección poliglandular autoinmune constituye una rareza clínica; de todas las variantes, el síndrome poliglandular autoinmune tipo II (SPGA-II) es el más común, el cual está caracterizado fundamentalmente por la presencia de la enfermedad de Addison autoinmune combinada con tiroiditis autoinmune y diabetes mellitus tipo 1. Este síndrome ocurre fundamentalmente alrededor de la tercera y cuarta décadas de la vida, donde se reporta comúnmente en mujeres con relación a los hombres, con una proporción de 3-4:1. Objetivo: presentar un caso clínico de un síndrome de Schmidt-Carpenter. Caso clínico: paciente femenina de 35 años de edad que presenta a los 20 años diabetes mellitus tipo 1, seguida nueve años después de una tiroiditis de Hashimoto, y en los últimos cincos años amenorrea alternando con metrorragias y tres abortos espontáneos; en el ingreso hospitalario se constata alopecia y un complejo sintomático compatible con insuficiencia suprarrenal. Los estudios clínicos y analíticos comprobaron la presencia de un síndrome de Schmidt-Carpenter asociado a hipogonadismo y alopecia. Conclusiones: este síndrome es una rara enfermedad severa de múltiples glándulas endocrinas causada por trastornos inmunes con destrucción de los tejidos. El diagnóstico es clínico, comprobado por la determinación de los niveles hormonales y las pruebas de inmunidad. Se debe diferenciar de otros procesos inmunes, cromosómicos, hematológicos y digestivos que afectan diferentes glándulas y órganos. La terapéutica empleada fue eficaz. Esta enfermedad es importante para las especialidades clínicas, especialmente la medicina interna, la endocrinología, la inmunología y la genética.

Background: polyglandular autoimmune syndrome type II is a clinical rarity; among all variants this syndrome is the most common. It is mainly characterized by the presence of autoimmune Addison´s disease combined with autoimmune thyroiditis and type I diabetes mellitus. This syndrome appears around the third and fourth decades of life. It is more frequent in women than in men, in a ratio of 3-4:1. Objective: to present a clinical case of Schmidt-Carpenter syndrome. Clinical Case: a thirty-five-year-old female patient who presented type I diabetes mellitus at the age of 20 and nine years later a Hashimoto´s thyroiditis. In the last five years the patient presented amenorrhea alternated with metrorrhagia and had three miscarriages. After her hospital admission, it was established alopecia and a symptomatic complex compatible with adrenal insufficiency. Clinical and analytical studies confirmed the presence of Shmidt-Carpenter syndrome associated with hypogonadism and alopecia. Conclusions: this syndrome is a rare and severe disease that affects multiple endocrine glands caused by immune disorders with destruction of tissues. The diagnosis is clinical, confirmed by the establishment of hormonal levels and immunity tests. This syndrome should be differentiated from other immune, chromosomal, hematological, and digestive processes that affect other glands and organs. The therapeutics employed was effective. This disease is relevant to clinical specialties, particularly for internal medicine, endocrinology, immunology, and genetics.

Pelagra: enfermedad antigua y de actualidad / Pellagra: an old disease and the present times

Fundamento: la pelagra endémica ha sido erradicada en la mayor parte del mundo, desde hace más de 50 años. En la actualidad existen casos esporádicos con dificultades socioeconómicas, dietas inadecuadas, alcoholismo y otras enfermedades que bloquean la absorción de la niacina. Objetivo: exponer un caso clínico de pelagra. Caso clínico: paciente masculino, blanco de 35 años de edad, desocupado, alcohólico crónico que ingresa por una dermatitis, diarreas y cuadro psiquiátrico. Los exámenes practicados arrojan resultados inespecíficos. Conclusiones: la pelagra no es una enfermedad de difícil diagnóstico, no obstante, algunas veces pasa inadvertida, fundamentalmente por su rara incidencia; es una enfermedad curable, pero si no se inicia el tratamiento oportunamente puede llevar a la muerte. El diagnóstico se establece por los antecedentes, la clínica y la respuesta a una dieta balanceada, con adición de ácido nicotínico o nicotinamida y complejo B.

Background: endemic pellagra was eradicated in most part of the world more than 50 years ago. Nowadays, there are sporadic cases of patients with socioeconomic problems, inadequate diets, alcoholism, and other diseases that block the absorption of niacin. Objective: to present a clinical case of a patient with pellagra. Clinical case: a thirty-five-year-old white male patient with problems of chronic alcoholism that was admitted in the hospital because of dermatitis, diarrhea, and psychiatric manifestations. The tests made to the patient did no show any specific result. Conclusions: pellagra is not a disease of difficult diagnosis; nevertheless, it sometimes goes unnoticed due to its rare incidence. It is a curable disease but if the treatment does not start at the appropriate time it may cause death. The diagnosis is established according to the antecedents, the clinic, and the response to a balanced diet together with niacinamide, niacin, and complex of vitamins B.

Linfadenitis axilar primaria tuberculosa, dificultades en el diagnóstico: presentación de un caso / Tuberculous primary axillary lymphadenitis: their difficulties in diagnosis

La linfadenitis axilar primaria tuberculosa sin otra enfermedad asociada, es una enfermedad infrecuente.Objetivo: presentar un caso de linfadenitis axilar primaria de origen tuberculoso en una paciente.Caso Clínico: paciente de 25 años, femenina, de piel blanca, con antecedentes de haber sido ingresada hace tres años por síndrome adenico por lo cual fue estudiada, al año de su egreso presenta adenopatías en la región lateral derecha del cuello, es estudiada por consulta externa donde se le realizó múltiples exámenes, estudio histopatológico de ganglio, imagenológicos etc., diagnosticándole una adenitis inespecífica. Es ingresada por presentar una tumoración en axila derecha de más o menos 4,5 a 5cm, de aproximadamente un año de evolución, con crecimiento lento, lobular que no ocasiona ningún tipo de molestias.Conclusiones: la tuberculosis extrapulmonar es infrecuente. La afectación ganglionar es mayormente reportada pero sobre todo en los ganglios del cuello, muy rara en la región axilar. La presentación clínica por lo regular es asintomática. El diagnóstico definitivo viene dado por la epidemiología, prueba de tuberculina, la imagenología y fundamentalmente la histopatología, ya que esta enfermedad tiene un gran número importante de diagnósticos diferenciales

Tuberculous primary axillary lymphadenitis without other associate manifestation is a rare disease.Objective: to present a case of primary axillary lymphadenitis caused by tuberculosis in a patient.Clinical case: 25 years-old, female, white skin patient admitted three years ago by adenic syndrome, after a year of being discharge she presented adenopathy in the right lateral region of the neck, she was studied by external consultation where multiple tests were carried out like: histopathological study of the ganglion, imaging etc., diagnosing a nonspecific adenitis. She is admitted by presenting a right axillary tumor of 4.5- 5 cm, approximately with one year of evolution, with slow, lobular growth that does not cause any kind of discomfort.Conclusions: extrapulmonary tuberculosis is uncommon. The ganglionic form is the most reported, particularly those in the neck, very rare in the axillary region. The clinical presentation usually has no symptoms. The epidemiology, tuberculin test, imaging and mainly histopathology give the definitive diagnosis; because this disease has a great number of differential diagnoses