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Background Given the current climate of the pandemic, lung cancer patients are especially vulnerable to complications from severe acute respiratory syndrome coronavirus 2 infection. As a high-risk population group, these patients are strongly advised to receive coronavirus disease 2019 vaccination in accordance with Center for Disease Control and Prevention guidelines to minimize morbidity and mortality. In recent years, immunotherapy has taken a preeminent role in the treatment of non-small cell lung cancer with dramatic improvement in overall survival. Reactive lymphadenopathy following the administration of a coronavirus disease 2019 vaccination can confound the radiographic interpretation of positron emission tomography–computed tomography or computed tomography scans from lung cancer patients receiving immunotherapy. Case presentation Here, we present a case of a 61-year-old Caucasian female and former smoker who developed cervical, hilar, supraclavicular, mediastinal, and left retroauricular lymphadenopathy following her coronavirus disease 2019 booster vaccination. At the time, she had been receiving long-term immunotherapy for the treatment of advanced lung adenocarcinoma. Biopsy was pursued owing to concerns of treatment failure and confirmed recurrent malignancy. Conclusion This case report highlights the importance of lymph node biopsies in lung cancer patients who present with contralateral lymphadenopathy following coronavirus disease 2019 vaccination to rule out tumor recurrence in this deserving patient population.

Context.--Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive form of fungal sinusitis, which remains a significant cause of morbidity and mortality. Early diagnosis and intervention are keys to improving patient outcomes. Intraoperative consultation has shown promise in facilitating early surgical intervention, but the accuracy of frozen section has not been clarified in this setting. Objectives.--To assess the accuracy of frozen-section diagnosis in patients with clinically suspected AIFRS. Design.--All cases of clinically suspected AIFRS during a 10-year period (2009-2019) were retrospectively reviewed. The frozen-section results were compared with the final permanent sections as well as the tissue fungal culture results, following which the accuracy of frozen section was determined. Results.--Forty-eight patients with 133 frozen-section evaluations for AIFRS were included in the study. Thirty of 48 patients and 61 of 133 specimens were positive for AIFRS on final pathology. Of 30 positive patients, 27 (90%) had at least 1 specimen diagnosed as positive during intraoperative consultation; among the 61 positive specimens, 54 (88.5%) were diagnosed as positive during intraoperative consultation. Of 72 negative specimens, all were interpreted as negative on frozen section. Thus, frozen sections had a sensitivity of 88.5% (95% CI, 0.78-0.97), specificity of 100% (95% CI, 0.94-1), positive predictive value of 100% (95% CI, 0.92-1), and negative predictive value of 90.6% (95% CI, 0.82-0.97). Conclusions.--This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. These findings are useful in frozen section-informed intraoperative decision making. (Arch Pathol Lab Med. 2021;145:648-656; doi: 10.5858/arpa.2019-0696-OA

Primary lung tumours are rare in paediatric patients. Mucoepidermoid carcinoma (MEC), typically low-grade and diagnostically straightforward, is the second most common tumour of the bronchus after carcinoid tumours. However, rare MEC may show divergent differentiation, be misdiagnosed as low-grade adenocarcinoma, not otherwise classified, and pose clinical challenges, especially when mastermind-like protein 2 (MAML2) gene arrangement is negative by fluorescence in situ hybridisation (FISH). Here, we report an MAML2 FISH-negative low-grade bronchial tumour in a juvenile patient that demonstrates both mucoepidermoid and acinar differentiation based on morphology and immunophenotype. Next-generation sequencing identified a CREB regulated transcription coactivator 3 (CRTC3::MAML2) fusion gene, located upstream of traditional translocation points and potentially undetectable by currently available FISH probes. This tumour appears to be a novel presentation of a bronchial tumour with dual mucoepidermoid and acinar differentiation, first described as mucoacinar carcinoma—a newly proposed subtype of MEC, originally described in the major salivary gland.

INTRODUCTION:Appendiceal orifice bleeding is an uncommon etiology of lower gastrointestinal bleeding and is often attributed to various appendix pathologies. We report a case of appendiceal orifice bleeding in a woman with fibrous obliteration of the appendix.CASE DESCRIPTION/METHODS:A 51-year-old female with fibromyalgia and chronic abdominal pain underwent outpatient colonoscopy to evaluate several months of intermittent hematochezia. Hemoglobin four months prior to procedure was 12.3 g/dL. Colonoscopy revealed fresh blood in the cecum and right colon. After irrigation, active oozing from the appendiceal orifice was seen. There was no blood in the terminal ileum. She was also found to have a non-bleeding rectal AVM, which was cauterized. Hemoglobin the day of procedure was 11.8. She had normal vitals and physical exam. A CT scan obtained three days later revealed a normal appendix and GI tract. She was referred to general surgery and underwent laparoscopic appendectomy three months later. She reported intermittent hematochezia two months after her surgery but did not pursue further work up. Her next follow up encounter was 15 months after her surgery and no further hematochezia was reported. Pathology analysis of her appendix revealed fibrous obliteration with foci of neural hyperplasia and entrapped residual neuroendocrine nests. There was no evidence of cellular atypia, mitotic activity, or neoplasm.DISCUSSION:Available literature on appendiceal orifice bleeding is sparse and mainly compromised of isolated cases. Most case reports involve acute, inpatient situations and abnormal CT findings, so it is important to underscore the decision to pursue a CT scan despite our patient’s chronic and mild presentation. The recurrent hematochezia two months after surgery is difficult to explain, but it did resolve by the time she re-established care and could be unrelated. Pathology findings did not include previously noted etiologies of appendiceal orifice bleeding (erosions, diverticula, malignancy). However, fibrous obliteration of the appendix is a rare finding and occurs when spindle cell proliferation replaces the appendiceal lumen. Fibrous obliteration of the appendix is also termed neurogenic appendicitis or appendiceal neuroma. There does not appear to be any previous associations of documented appendiceal orifice bleeding and fibrous obliteration of the appendix. Our case highlights the need for further investigation into these two rare entities.