Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting form of necrotizing lymphadenitis that primarily affects young adults and often mimics lymphoma or autoimmune lymphadenitis both clinically and histologically. We report the case of a 28-year-old Caucasian woman with a history of Hashimoto's thyroiditis presenting with progressive cervical lymphadenopathy, fever, weight loss, and myalgia. Laboratory findings showed leukopenia, elevated transaminases, and increased LDH. Imaging revealed bilateral lymphadenopathy and mildly enlarged spleen. Histopathological examination of an excised lymph node demonstrated necrotizing lymphadenitis with crescent-shaped histiocytes, plasmacytoid dendritic cells, and karyorrhectic debris. Immunohistochemistry supported the diagnosis and excluded lymphoma, while electron microscopy did not provide evidence of infection. The patient recovered fully without specific treatment. This case highlights the importance of recognizing the characteristic features of KFD to avoid misdiagnosis and overtreatment. Given its potential association with autoimmune disease and recurrence, clinical follow-up is recommended.

Lymphoblastic lymphoma (LBL) is a highly aggressive malignancy composed of immature lymphocytes of B- cell or T-cell origin. LBL is typically distinguished from acute lymphoblastic leukemia (ALL) by the presence of fewer than 20% bone marrow blasts. This retrospective multicenter cohort study evaluated the clinical data of adult LBL patients diagnosed and treated at tertiary centers in Türkiye.

PurposeHead and neck unicentric Castleman disease (HN-UCD) often lacks specific clinical and laboratory markers, leading to frequent preoperative misdiagnoses. While surgical resection typically offers a favorable prognosis, the management of atypical postoperative outcomes, such as new regional lymphadenopathy or persistent systemic symptoms, remains poorly defined. This study aimed to identify the characteristic imaging features of HN-UCD and explore effective management strategies for these atypical postoperative scenarios.MethodsA retrospective analysis was conducted on 24 patients diagnosed with HN-UCD at the Peking Union Medical College Hospital over the past 20 years. The preoperative imaging characteristics and postoperative clinical outcomes were systematically evaluated.ResultsImaging confirmed significant hypervascularity as a hallmark of HN-UCD: 94.4% (17/18) of lesions exhibited abundant and disordered blood flow signals on ultrasound, and 71.4% (10/14) of lesions presented with prominent feeding vessels on CT. Postoperatively, 87.5% (21/24) of the patients achieved complete remission within the surgical field. For the two patients exhibiting atypical outcomes (new regional lymphadenopathy and persistent fever), a strategy of rigorous follow-up was adopted after multidisciplinary exclusion of malignancy and infection; both patients remained clinically stable.ConclusionProminent feeding vessels and marked hypervascularity are characteristic preoperative imaging markers for HN-UCD. For patients with atypical postoperative outcomes, a management protocol based on multidisciplinary evaluation and close clinical observation is recommended.

Malignant proliferating trichilemmal tumors (MPTTs) are rare, rapidly growing lesions often originating from a small cyst on the scalp. We present a case of a 61-year-old woman who presented due to concern for increased bleeding from an extremely large cystic mass on her posterior scalp, measuring 22 × 10 × 15.2 cm. She reported that the mass began as a cyst approximately 10 years before presentation but had grown rapidly in the last 3 years, causing her significant pain. Dermatopathology revealed a suspected diagnosis of an MPTT based on a punch biopsy. An interdisciplinary surgical team was organized, including otolaryngology, neurosurgery, and plastic surgery, to pursue surgical excision and reconstruction of her complex mass. Intraoperative histopathology demonstrated cytological atypia, necrosis, and infiltrative growth, confirming the suspected diagnosis of an MPTT. Following successful tumor removal, her scalp defect was closed using a latissimus dorsi free flap. Eleven months postoperatively, the patient's scalp was well-healed, with no signs of tumor recurrence. Our case is unique due to the tumor's exceptional size, malignant histology, and the patient's delay in seeking treatment despite its burdensome size and location. As seen in our patient, an initially benign cyst can rapidly progress to a large tumor, causing pain and distress. Additionally, such large masses can cause significant reactive lymphadenopathy. MPTTs carry a small but significant risk of local recurrence and metastasis. Removal of such large tumors, particularly those on the scalp, necessitates a well-coordinated effort from a multidisciplinary surgical team to ensure optimal excision, reconstruction, and patient relief.

Oral mucosal melanoma is a rare malignancy of the oral cavity and a small subset of melanomas overall, characterized by an aggressive clinical course and diagnostic challenges. These challenges are particularly pronounced in amelanotic variants due to the lack of pigmentation and their histological resemblance to other spindle cell and epithelial tumors. This report describes a 47-year-old man who presented with a progressively enlarging ulcero-exophytic lesion involving the maxilla and hard palate over nine months, accompanied by cervical lymphadenopathy and rapid development of brain metastasis. Initial histopathological evaluation suggested a spindle cell malignancy; however, immunohistochemical analysis demonstrated positivity for S-100, SOX10, and Melan-A, confirming malignant melanoma. This diagnosis was further supported by repeat biopsy and histopathological findings. Despite treatment with pembrolizumab, the disease progressed rapidly both locally and distantly, necessitating palliative care. This case highlights the persistent challenges in diagnosing oral mucosal melanoma due to its atypical clinical and pathological features, emphasizes the critical role of immunohistochemistry in achieving an accurate diagnosis, and underscores the generally poor prognosis despite current therapeutic options. It also reinforces the importance of early detection and timely multidisciplinary management.

Surgery serves as a crucial therapeutic modality for gynecological malignancies, occupying a central role in the multimodal treatment framework for common gynecological cancers including cervical cancer, ovarian cancer, endometrial cancer, and vulvar cancer. Its clinical value extends across the early, middle, and advanced stages of tumors, encompassing multiple therapeutic objectives such as radical resection, cytoreductive therapy, and palliative relief. This video showcases the laparoscopic en bloc excision of enlarged obturator lymph nodes, focusing on key technical strategies for safe and effective dissection in the complex pelvic anatomical region-where close proximity to critical structures like the obturator nerve and iliac blood vessels poses inherent risks. The patient was initially planned for laparoscopic total hysterectomy due to cervical intraepithelial neoplasia grade III (CIN III), with no preoperative imaging or clinical indicators suggesting the need for lymphadenectomy. During the procedure, the surgical team unexpectedly identified enlarged, firm obturator lymph nodes, which postoperative pathological analysis confirmed as metastases from urethral squamous cell carcinoma-a known primary tumor prone to pelvic lymph node spread. The surgical approach prioritized meticulous anatomical landmark identification (including the obturator nerve and vascular bundles), strict adherence to fascial plane boundaries, and combined use of blunt dissection and precise suturing. These techniques minimized the risk of vascular injury and nerve palsy, common complications in pelvic lymphadenectomy. This case underscores the feasibility and safety of laparoscopic management for complex pelvic lymphadenopathy when guided by refined surgical skills, leveraging the technology's high-definition visualization advantage. As a medical educational resource, the video aims to equip surgeons with practical insights to enhance their technical proficiency in dissecting lymph nodes within high-risk anatomical areas, supporting improved intraoperative decision-making and patient outcomes.

Iodinated contrast media are essential diagnostic tools widely used in radiographic and computed tomography (CT) examinations, with millions of procedures performed annually. Although generally well tolerated, these agents can, rarely, cause adverse reactions, including hypersensitivity reactions, acute kidney injury, and contrast-induced sialadenitis (iodide mumps). Contrast-induced sialadenitis is an uncommon, benign reaction to iodinated contrast media that most frequently involves the parotid glands and is likely underrecognized. Submandibular gland involvement with associated cervical lymphadenopathy is particularly rare and may mimic infectious or obstructive salivary gland pathology. We report a case of a 64-year-old woman who developed acute bilateral submandibular swelling and pain three to four hours after iodinated contrast administration for a CT performed to evaluate acute abdominal pain. The patient had a history of similar, self-limited episodes following prior contrast exposure. Physical examination revealed diffuse submental and submandibular swelling with mild tenderness but no signs of infection or airway compromise. Ultrasound demonstrated bilateral submandibular gland enlargement with heterogeneous echotexture, increased vascularity, and reactive cervical lymphadenopathy. Based on the temporal relationship to contrast exposure, prior similar episodes, absence of infectious features, and supportive imaging findings, a diagnosis of contrast-induced submandibular sialadenitis was made. Symptoms improved rapidly with conservative management and resolved within two days. This case highlights the importance of recognizing contrast-induced submandibular sialadenitis as a rare but benign and self-limiting condition. Awareness of this entity can help clinicians avoid unnecessary antibiotics, corticosteroids, and extensive diagnostic workup. Proper recognition and documentation are also important for counseling patients about future contrast exposure and considering alternative imaging modalities when appropriate.

Primary lymphoma of the tongue base is exceptionally rare and often presents with nonspecific clinical features, making early diagnosis challenging. We report the case of a 47-year-old male, a chronic smoker with poor oral hygiene and no notable medical history, who presented with a painless mass at the base of the tongue and mild lingual discomfort. Initial empirical antibiotic therapy for a presumed abscess was ineffective. Magnetic resonance imaging revealed an infiltrative lesion with ipsilateral submandibular lymphadenopathy. Histopathology confirmed diffuse large B-cell lymphoma (DLBCL). Fluorodeoxyglucose (FDG)-PET/CT staging demonstrated localized disease (Ann Arbor stage IEA). The patient was treated with six cycles of rituximab, cyclophosphamide, doxorubicin (hydroxydaunorubicin), vincristine (Oncovin), and prednisone (R-CHOP) immunochemotherapy and intrathecal methotrexate prophylaxis. Post-treatment imaging confirmed complete remission. Primary involvement of the tongue base by DLBCL is an uncommon presentation that can mimic benign or infectious processes. Imaging and histopathology play key roles in diagnosis, while systemic immunochemotherapy remains the mainstay of treatment. Early consideration of lymphoma in tongue base masses unresponsive to medical therapy enables timely diagnosis and effective management.

Tuberculosis (TB) remains one of the primary causes of illness and death worldwide. Indonesia ranks second globally in TB incidence. Recurrent or relapsed TB, especially with multifocal involvement, presents significant diagnostic and therapeutic challenges, often complicated by incomplete treatment and limited molecular diagnostic capacity in developing countries. We present the case of a 26-year-old woman with a history of pulmonary, lymphatic, and skeletal tuberculosis who developed recurrence shortly after completing a 12-month anti-tuberculosis regimen (August 2024-July 2025) that excluded pyrazinamide due to gastrointestinal intolerance. She presented again in September 2025 with right-sided chest pain, productive cough, and cervical lymphadenopathy. Chest radiography revealed bilateral infiltrates, and abdominal ultrasonography suggested tuberculous myositis. The pulmonary findings, positive GeneXpert MTB/RIF Ultra result, and cervical lymph node biopsy confirming caseating granulomatous lymphadenitis were identified during the initial emergency department admission, while pus culture from the osteomyelitis lesion grew Staphylococcus aureus. The abdominal findings, including a left iliopsoas abscess with involvement of the iliacus muscle suggestive of tuberculous myositis, were detected later during outpatient follow-up evaluation, after the patient continued to experience persistent abdominal pain. The patient subsequently underwent a second course of treatment with a complete first-line anti-tuberculosis regimen combined with additional antibiotic therapy, which resulted in significant clinical improvement. In a follow-up, it was surprising that the sequence analysis of a 561 bp fragment of rpoB showed a single nucleotide deletion in comparison to the reference sequence. A six-month treatment regimen (BPaLM) has been planned as the selected regimen. This case illustrates the complexity of managing recurrent multifocal TB and underscores the need for rapid and comprehensive molecular diagnostic tools.

Tonsillar actinomycosis is an uncommon chronic infection that can clinically and radiologically mimic malignancy. Because of its nonspecific presentation and tumor-like appearance, particularly when associated with cervical lymphadenopathy, it often poses a diagnostic challenge. A 20-year-old patient presented with a four-month history of progressive left tonsillar hypertrophy. Nasofibroscopy showed an irregular tonsillar surface with nasopharyngeal bulging, raising suspicion of a neoplastic lesion. Contrast-enhanced CT revealed asymmetric left tonsillar enlargement with homogeneous thickening of the nasopharyngeal wall and suspicious contralateral lymph nodes. Laboratory findings were within normal limits. The patient underwent left tonsillectomy with adenoidectomy. Histopathological examination demonstrated tonsillar hyperplasia containing Actinomyces colonies and adenoidal lymphoid hyperplasia, without evidence of malignancy. The patient received a six-week course of oral amoxicillin, resulting in complete regression of the cervical lymphadenopathy and no recurrence during follow-up.This case underlines the importance of considering tonsillar actinomycosis in the differential diagnosis of unilateral tonsillar hypertrophy mimicking malignancy, especially when accompanied by cervical lymphadenopathy. Early histopathological diagnosis and combined surgical and antibiotic therapy ensure optimal outcomes while avoiding unnecessary radical procedures.