A rapidly growing palatal swelling poses a diagnostic challenge due to its wide differential, including odontogenic, epithelial, salivary gland, mesenchymal and haematolymphoid pathologies. We report the case of an elderly female with a history of treated breast carcinoma who presented with a solitary palatal mass. Clinical and radiographic findings initially raised suspicion of a metastatic lesion because of the patient's previous malignancy, rapid lesion enlargement, firm fixation, bone erosion, sinus extension and cervical lymphadenopathy. However, histopathological examination and immunohistochemistry confirmed a diagnosis of extranodal diffuse large B-cell lymphoma rather than metastatic breast carcinoma, establishing it as a second primary malignancy. The patient was placed on palliative care due to her advanced age and compromised systemic condition but succumbed within 1 month. This case underscores the importance of including lymphoma in the differential diagnosis of rapidly enlarging oral swellings, even in patients with a remote history of solid-organ malignancy, and highlights the critical role of immunophenotyping in distinguishing lymphoid neoplasms from more common oral pathologies.

An 89-year-old female patient was diagnosed with stage IVA cervical carcinoma with bladder involvement and a concomitant perianal squamous cell carcinoma and perianal lesions, HPV positive. Due to a significant decline in quality of life (Scale ECOG 3), she initiated radiotherapy without chemosensitization. She completed a pelvic radiotherapy regimen of 4600 cGy, resulting in an improved performance status (ECOG 0), although anal lesions persisted. Given this finding, electrochemotherapy was initiated. Two sessions were administered over four months, with minimal adverse effects and no negative impact on the quality of life. The patient achieved a complete response according to RECIST criteria. Nine months post-electrochemotherapy, MRI showed no evidence of distant pelvic disease, locoregional lymphadenopathy, or anorectal, vaginal or perianal involvement.

We report the case of a 60-year-old man who initially presented in October 2021 with a history of recurrent itchy skin lesions across exposed areas of his body such as the neck and extremities. As per history and clinical examination, the lesions were initially interpreted as an insect bite reaction for which the patient was provided with symptomatic treatment. Despite the treatment, the patient continued to experience recurrent skin lesions. Histopathologic exam of a skin biopsy showed eosinophil-rich superficial and deep inflammatory infiltrates which supported the diagnosis of a cutaneous reaction to an insect bite or another hypersensitivity-type reaction which further made the diagnosis challenging. In 2024, he developed systemic symptoms such as dizziness, vomiting, and generalized lymphadenopathy. Laboratory tests revealed significant leukocytosis with persistent lymphocytosis, mild anemia, and thrombocytopenia. A peripheral smear was done and showed mature lymphocytosis with smudge cells. Flow cytometry identified a clonal B-cell population expressing CD5, CD23, CD200, and lambda light-chain reaction, supporting a diagnosis of chronic lymphocytic leukemia. Positron emission tomography-computed tomography (PET-CT) demonstrated hypermetabolic lymphadenopathy above and below the diaphragm and hepatosplenomegaly. Cutaneous manifestations resembling different benign dermatologic conditions, such as an insect bite reaction, may rarely precede systemic symptoms of an underlying hematologic malignancy. This case emphasizes the significance of reassessment and follow-up in patients with recurrent and evolving dermatological findings.

The synchronous occurrence of papillary thyroid carcinoma (PTC) and chronic lymphocytic leukemia (CLL) is rare and poses diagnostic challenges, particularly in distinguishing metastatic thyroid disease from hematological lymphadenopathy. The present report documents the case of a 64-year-old female patient with long-standing CLL who presented with a malignant thyroid nodule accompanied by multiple enlarged cervical lymph nodes. A diagnosis was established through integrated immunohistochemistry, flow cytometry and multimodal imaging. After the diagnosis of synchronous PTC and CLL/SLL was confirmed, the patient underwent a total thyroidectomy with central compartment lymph node dissection. In addition, a focused review of the literature was conducted to contextualize the clinical presentation, diagnostic strategies and management approaches. Treatment and follow-up were guided by a multidisciplinary team. No adverse events occurred during follow-up. At the latest follow-up in November 2025, the patient remained clinically stable, with no evidence of PTC recurrence or CLL progression, and thyroid function test results showed decreased T3, elevated T4 and free T4, mildly elevated thyroid-stimulating hormone, and free T3 within the reference range. The present case highlights the importance of a comprehensive diagnostic work-up and provides practical guidance for the diagnostic and therapeutic management of patients with dual malignancies.

Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting condition characterized by histiocytic necrotizing lymphadenitis that predominantly affects young adults. The clinical presentation often mimics more serious conditions such as tuberculosis and lymphoma, posing a significant diagnostic challenge. We report a case of KFD in a middle-aged adult. A 46-year-old female presented with left posterior cervical lymphadenopathy and fever of 2 weeks' duration. Extensive workup, including tuberculosis screening with GeneXpert, Mantoux test, and culture, was all negative. Ultrasonography and computed tomography revealed multiple necrotic cervical lymph nodes with bilateral involvement. Excisional lymph node biopsy was done, and histopathology revealed patchy areas of necrosis with karyorrhectic debris, proliferation of histiocytes and immunoblasts, and absence of neutrophilic infiltration suggestive of KFD. The patient was given symptomatic treatment and showed complete resolution of symptoms at follow-up. This case emphasizes the importance of considering KFD in the differential diagnosis of cervical lymphadenopathy, particularly when routine investigations for tuberculosis and malignancy are negative. Excisional lymph node biopsy remains the gold standard for diagnosis.

Background/Objectives: Early identification of high-grade lymphoma in children presenting with cervical lymphadenopathy is essential to ensure timely referral while avoiding unnecessary invasive procedures. We have previously developed a diagnostic model to support referral decisions. The aim of this study was to validate this model in an independent cohort and improve it based on clinical feedback and new data. Methods: We included 255 pediatric patients with cervical lymphadenopathy, of whom 62.4% were diagnosed with malignancy. External validity was assessed by applying the original scoring model to the new dataset and calculating the sensitivity, specificity, and area under the curve (AUC). Thereafter, the model was updated by addressing overlapping predictors, and evaluating additional variables that were identified through univariate analysis. Results: The original model demonstrated stable performance in the new cohort, with sensitivity and specificity remaining within the previously reported 95% confidence intervals. No new clinically relevant predictors emerged beyond those already included in the original model. Model refinement resulted in a simplified model with 9 variables (reduced from 12), which improved clinical usability by reducing redundancy among predictors and facilitating implementation in routine practice. The revised model showed stable diagnostic accuracy with a sensitivity of 94% and specificity of 91% in the new dataset. Conclusions: Our updated diagnostic nine-factor model maintains high diagnostic performance while having a reduced number of variables. These findings support its use as a practical tool for early identification of children at risk of high-grade lymphoma.

This report presents a within-patient comparison of [18]F-rhPSMA-7.3 and [18]F-PSMA-1007 PET/CT in a 71-year-old man with Gleason score 4 + 3 = 7, pT3bN1 metastatic castration-resistant prostate cancer after robot-assisted radical prostatectomy, multiple androgen-deprivation and androgen receptor-directed treatments, and radiotherapy for para-aortic nodal metastases. The scans showed concordant PSMA-avid cervical-to-mediastinal lymphadenopathy and an ill-defined right lower-lobe pulmonary lesion with a recorded SUVmax > 15, despite distinct physiologic biodistributions. Infection or inflammation remained a relevant differential diagnosis, and the patient declined biopsy. Antibiotics did not improve the CT findings. After enrollment in a clinical trial of systemic therapy, the last available pretreatment prostate-specific antigen (PSA) level of 42.4 ng/mL decreased to 3.1 ng/mL, with marked disease regression. The concordant dual-tracer findings, lack of response to antibiotics, and subsequent radiographic and biochemical response to systemic therapy favored nodal and pulmonary metastases from prostate cancer. However, without histopathologic confirmation, the diagnosis remains presumptive, highlighting the need to integrate PET biodistribution, semiquantitative uptake, anatomic imaging, and longitudinal clinical findings.

A 25-year-old woman presented to the emergency department (ED) with acute chest tightness and dyspnea superimposed on a one-year history of diffuse, treatment-refractory pruritus that had been managed as eczema at two prior visits. She also reported night sweats and unintentional weight loss. Laboratory studies showed marked leukocytosis, transaminitis, critical hypokalemia and hypomagnesemia, and an elevated lactate dehydrogenase. No lymphadenopathy was palpable on examination. Chest radiography and computed tomography revealed a large, locally invasive right upper lobe mass with mediastinal, hilar, and cervical lymphadenopathy. The patient was transferred for tissue diagnosis, which confirmed nodular sclerosis classical Hodgkin lymphoma. Pruritus is a common ED complaint that typically reflects benign dermatologic disease; however, paraneoplastic pruritus can be the earliest sign of classical Hodgkin lymphoma and is frequently mistaken for eczema, potentially delaying diagnosis. Chronic, refractory pruritus accompanied by systemic symptoms or unexplained laboratory abnormalities warrants chest imaging, even without palpable lymphadenopathy, as it may represent an early, treatable presentation of Hodgkin lymphoma.