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It has been nearly half a century since angioimmunoblastic T-cell lymphoma (AITL) was characterized in the early 1970’s. Our understanding of the disease has dramatically changed due to multiple discoveries and insights. One of the key features of AITL is aberrant immune activity. Although AITL is now understood to be a neoplastic disease, pathologists appreciated that it was an inflammatory condition. The more we understand AITL at cellular and genetic levels, the more we view it as both a neoplastic and an inflammatory disease. Here, we review recent progress in our understanding of AITL, focusing on as yet unsolved questions.

Lymph node enlargement can be present at any stage of the HIV infection, reactive to HIV itself, another infection, or a malignant source. The aim of our study was to describe the causes of lymphadenopathy in the people living with HIV (PLHIV) of French Guiana, a French territory in the Amazon region. A retrospective multicenter case series was conducted between January 2005 and December 2021. Inclusion population consisted of PLHIV who underwent a fine needle aspiration or a biopsy of a lymph node that was analyzed at the Department of Pathology of Cayenne hospital. We included 152 adults, with a median age of 43 [35-51] years and median CD4 count of 185/mm3 [60-344]. The main causes of lymphadenopathy were: histoplasmosis (25%, CI95%: 18-33), followed by tuberculosis (24%, CI95%: 18-32), HIV-reactive lymphadenitis (21%, CI95%: 15-29) and lymphoproliferative disorder (11%, CI95%: 7-18). Multiple causes were present in 6% of cases. Opportunistic infections represented 53% (CI95%: 44-61) of cases. The main characteristics associated with opportunistic disease (infectious or neoplastic) were lymph node > 5 cm, CD4 count < 200/mm3, hepatomegaly or splenomegaly and the presence of extra-ganglionic symptoms. For the last 17 years, opportunistic infections represented 53% of the causes of lymphadenopathy among PLHIV. Histoplasmosis, already recognized as the first AIDS-defining condition and first cause of AIDS-related deaths in French Guiana, is also the first cause of lymphadenopathy in PLHIV, ahead of tuberculosis and reactive lymphadenopathy. The CD4 count and the size of the lymph nodes appear to be the most important factors in the diagnostic process and should lead to a quick lymph node analysis in these patients.

The global COVID-19 vaccination campaign has raised concerns about potential side effects, including cardiac involvement or axillary lymphadenopathy. This study investigated the relationship between COVID-19 vaccination and thallium-201 myocardial perfusion imaging (Tl-201 MPI) findings, aiming to elucidate the impact of the vaccine impact on cardiac health. This retrospective analysis enrolled patients referred for MPI examination post-COVID-19 vaccination between June 2021 and January 2022. Eligible participants included symptomatic individuals without prior coronary artery disease (CAD) or with stable CAD, experiencing symptoms within one-month post-vaccination. MPI was conducted post dipyridamole-stress testing, and positive stress test results were further evaluated by cardiac catheterization. The association between vaccination and MPI results, including axillary lymphadenopathy presence, was assessed. Sixty-four patients were included, with a mean age of 54.7 years, and a predominance of males (64.3%). A notable incidence of positive MPI findings and axillary lymphadenopathy was observed, particularly in patients vaccinated with mRNA vaccines. Among the 15 patients with positive MPI, visible axillary lymphadenopathy was observed in 4 cases (26.7%), compared with 6 of 49 patients (12.2%) with negative MPI. Although this difference was not statistically significant, it suggests a possible trend toward a higher prevalence in the MPI-positive subgroup. Most patients with positive MPI findings had received the Moderna vaccine. Our findings indicate a potential link between mRNA COVID-19 vaccination and cardiac issues detected via MPI, as well as an increase in axillary lymphadenopathy. Although further prospective studies are warranted to establish causality, our findings underscore the importance of post-vaccination monitoring, particularly in symptomatic patients, and the need of continued efforts to comprehensively assess vaccine safety to help reduce mortality rates.

Background Tick-borne lymphadenopathy (TIBOLA) is a tick-borne disease transmitted by Dermacentor ticks and is usually caused by Rickettsia . In 2021, clinicians in northeastern France reported an increase in TIBOLA cases. Methods This entomo-clinical, multicenter, retrospective, and observational study aimed to describe the evolution of the number of TIBOLA cases between 2016 and 2021 in northeastern France as well as the evolution of the Dermacentor tick population. Results A total of 35 cases of TIBOLA were identified, 16 of which occurred in 2021, with clear predominance in April and May. A longitudinal study performed in the Alsace region (endemic for ticks and tick-borne diseases) revealed a peak in tick activity in 2021. A trend toward an increase in TIBOLA cases in 2021 in the northeastern region of France was observed, as was an increase in the Dermacentor tick population in some biotopes. Conclusions TIBOLA appears to be an emerging disease that should be monitored, as should the Dermacentor population. Graphical Abstract

Background The diagnosis of B-cell lymphoma, one of the commonest cancers seen in childhood and adolescence, is challenging. There is a crucial need to identify and delineate the prevalence of associated symptoms in order to improve early diagnosis. Aims To identify clinical presentations associated with childhood and adolescent B-cell lymphomas and estimate symptom prevalence. Methods A systematic review of observational studies and meta-analysis of proportions was carried out. Medline and EMBASE were systematically searched, with no language restrictions, from inception to 1st August 2022. Observational studies with at least 10 participants, exploring clinical presentations of any childhood and adolescent lymphoma, were selected. Proportions from each study were inputted to determine the weighted average (pooled) proportion, through random-effects meta-analysis. Results Studies reported on symptoms, signs and presentation sites at diagnosis of 12,207 children and adolescents up to the age of 20. Hodgkin’s lymphoma most frequently presented with adenopathy in the head-and-neck region (79% [95% CI 58%-91%]), whilst non-Hodgkin’s lymphoma presented abdominally (55% [95% CI 43%-68%]). Symptoms associated with lymphoma included cervical lymphadenopathy (48% [95% CI 20%-77%]), peripheral lymphadenopathy (51% [95% CI 37%-66%]), B-symptoms (40% [95% CI 34%-44%]), fever (43% [95% CI 34%-54%]), abdominal mass (46% [95% CI 29%-64%]), weight loss (53% [95% CI 39%-66%]), head-and-neck mass (21% [95% CI 6%-47%]), organomegaly (29% [95% CI 23%-37%]), night sweats (19% [95% CI 10%-32%]), abdominal pain (28% [95% CI 15%-47%]), bone pain (17% [95% CI 10%-28%]) and abnormal neurology (11% [95% CI 3%-28%]). Conclusion This systematic review and meta-analysis of proportions provides insight into the heterogeneous clinical presentations of B-cell lymphoma in childhood and adolescence and provides estimates of symptom prevalence. This information is likely to increase public and clinical awareness of lymphoma presentations and aid earlier diagnosis. This review further highlights the lack of studies exploring childhood and adolescent lymphoma presentations in primary care, where patients are likely to present at the earliest stages of their disease.

Background Cervical lymphadenopathy refers to a frequently observed clinical presentation in numerous pathological conditions. A wide spectrum of diseases can cause cervical lymphadenopathy, irrespective of the fact that the patients are infected with HIV or not. The present study focuses on validating whether the causes of cervical lymphadenopathy differ significantly in HIV and non-HIV patients by using fine-needle aspiration cytology (FNAC) combining cell block. Methods A total of 589 patients with cervical lymphadenopathy were recruited in the FNA clinic. The samples were obtained by an auto-vacuumed syringe that benefited the sampling more materials. The cytological smears were prepared by Hematoxylin and Eosin (HE), Periodic Acid Schiff (PAS), Gomori’s methenamine silver (GMS) and acid-fast staining. Cell blocks were made if required, and immunohistochemistry stain was performed on the cell block section. Results The study found 453 (76.9%) patients with HIV and 136 (23.1%) patients without HIV infection. The average age of HIV-infected patients was 34.8 ± 10.2 years, which was significantly lower than that of non-HIV-infected patients (42.9 ± 18.1 years) ( p  < 0.01). Of all patients infected with HIV, 390 (86.1%) were males. This proportion was significantly higher than that of non-HIV-infected patients [65/136 (47.8%)] ( p  < 0.01). The major causes of cervical lymphadenopathy in HIV positive patients were mycobacterial infection (38.4%), reactive hyperplasia (28.9%), non-specific inflammation (19.9%), and malignant lesions (4.2%). In contrast, the most common causes in HIV negative patients were reactive hyperplasia (37.5%), malignancy (20.6%), non-specific inflammation (19.1%) and mycobacterial infection (12.5%). Opportunistic infections such as non-tuberculous mycobacteria (4.2%), cryptococcosis (1.5%), Talaromyces marneffei (1.5%) and other fungi (0.4%) were found only in HIV-infected individuals. Non-Hodgkin’s lymphoma (2.4%) was the most common malignant lesion in patients with HIV infection, followed by Kaposi’s sarcoma (0.9%) and metastatic squamous cell carcinomas (0.7%). However, the most common malignancy in non-HIV-infected patients was metastatic carcinomas (14%) including small cell carcinomas, adenocarcinomas, squamous cell carcinomas and hepatocellular carcinoma, which were noticeably greater than the HIV patients ( p  < 0.01). Conclusions There were significantly different causes of cervical lymphadenopathy in HIV infected and non-HIV infected patients. FNAC was a useful diagnostic method for differential diagnosis of cervical lymphadenopathy.

Background and Objectives: Several authors have reported cervical and axillary lymphadenopathies as known side effects following anti-COVID-19 vaccine administration. Few data are available about atypical locations of post-anti-COVID-19 vaccine lymphadenopathy. In this investigation, we evaluated the incidence and prevalence of postvaccine lymphadenopathy ultrasound (US) features in atypical sites. Materials and Methods: In this retrospective study, we retrospectively selected 64 patients on whom US was performed between January and October 2021 due to COVID-19 vaccine-related lymphadenopathy. We investigated lymph node anatomical sites, presence, number, size, shape, cortical profile, hilum outline, superb microvascular imaging (SMI), and elastosonography. Results: A total of 170 nodes were assessed. Atypical location was demonstrated in 5/64 patients (7.8%). In all these cases, atypical nodal involvement was associated with lymphadenopathy in a typical site (axillary, supraclavicular) ipsilateral to the vaccine injection site. Two patients presented lymphadenopathy in the infraclavicular station (3.1%), one in the pectoralis major muscle (1.6%), one in the left arm (1.6%), and one in the nuchal site (1.6%). All lymphadenopathies were oval-shaped, with a median size of 0.9 ± 0.2 cm. US features included a symmetric cortex with hilum evidence (4/6, 60%), vascular signal at SMI in both the hilar region and periphery of lymph node (5/6, 83.3%), and a US elastography pattern resembling that of adjacent tissues (5/6, 83.3%). The median age of patients with lymphadenopathies in an atypical location was 23 years. The main type of vaccine associated with lymph node appearance in atypical sites was Moderna’s mRNA-1273 (60% of patients, 4/6 lymph nodes accounting for 66.7% among atypical locations). Conclusion: Post-COVID-19 vaccine administration lymphadenopathies in an atypical location represent an intense immune response to antigenic stimuli and they may show alarming US traits superimposed on malignant pathologies, which may complicate the patient’s clinical and diagnostic pathway. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients’ clinical background and delay of US exam to four to six weeks after vaccine injection should be considered.

ObjectiveThis study was conducted to characterize lymphoma occurring during pregnancy and to investigate the outcomes of the patients and the fetuses.MethodsClinical data were gathered retrospectively from 29 patients at 13 participating institutions, and data from 28 eligible patients were analyzed.ResultsSix (21%) patients had Hodgkin lymphoma (HL) and 22 (79%) patients had non-Hodgkin lymphoma (NHL). All patients with HL presented with lymphadenopathy, but 15 (68%) of the 22 patients with NHL presented with extranodal sites only. At the median follow-up period of 1325 (range 6–4461) days, the 5-year overall survival rate was 63% for patients with NHL and 100% for patients with HL. Three of the 13 patients who received chemotherapy during pregnancy (23%) developed Pneumocystis jiroveci pneumonia (PCP). There was 1 intrauterine fetal death, 1 spontaneous abortion in the first trimester, and 15 (54%) preterm births.ConclusionThis study showed a higher proportion of NHL than HL during pregnancy in Japan, which was inconsistent with the proportions observed in Western countries. The high incidence of maternal PCP and preterm birth suggested the need for improvements in our management of lymphoma during pregnancy.

ObjectivesTo describe a series of extrarectal lymphogranuloma venereum (LGV) cases diagnosed in France.MethodsConsecutive LGV cases confirmed at the French Reference Centre for chlamydiae with an extrarectal sample from January 2010 to December 2015 were included. The first part of the study consisted of a retrospective case note review and analysis. In a second part, the complete ompA gene sequence of our samples was determined.ResultsThere were 56 cases overall: 50 cases of genital LGV and six cases of pharyngeal LGV. Subjects were all men, median age 39 years, 27/53 were HIV-positive, 47/51 reported having sex with other men, 43/49 reported multiple sexual partners (a mean 25 in the last 6 months). Median time from symptom onset to diagnosis was 21 days. Subjects most commonly presented with inguinal adenopathy alone (19 of 50 genital cases) and adenopathy with genital ulcer (17 of 50). Three pharyngeal cases were symptomatic. Fever was reported in 11 cases. Inguinal abscess was reported in 22 of 42 cases presenting with lymphadenopathy. Co-infections were frequent: eight cases of syphilis, four non-LGV Chlamydia trachomatis infections, one case of gonorrhoea. Cure was always achieved with doxycycline therapy but prolonged treatment was necessary in eight cases with inguinal abscess. Genotyping according to ompA sequencing showed the co-circulation of genovars L2 (16 of 42 strains successfully typed) and L2b (24 of 42). There was no association between HIV status and disease severity or genovar distribution.ConclusionIn the span of 6 years, 56 extrarectal LGV cases were confirmed through genotyping in France. Extrarectal LGV seemed to share a common epidemiological background with rectal disease in terms of affected population and genovar distribution. HIV prevalence was lower than expected.

Background There are different causes of Incidental Enlarged MesentericLlymph Nodes (IMLN) found during laparotomy, which most of the time influence the postoperative course. These causes are variable across the globe, but the node pattern in our locality and the factors associated with the incidental enlarged mesenteric lymph nodes are not yet established. Due to the lack of an established protocol in our locality, there have been some mismanaged cases that led to several postoperative complications. Therefore, this study aimed to evaluate the prevalence, factors associated with, and histological pattern of incidental mesenteric lymphadenopathy. Methodology The 885 patients were conveniently recruited in the study. The incidental enlarged mesenteric lymph nodes were taken during surgery, processed and histologically analyzed as per pathological protocol. Obtained data were filled out and analyzed using SPSS version 27. Binary logistic regression was used to examine clinical data, with a significance level of p  < 0.05, to determine the factors linked to lymph node enlargement. Results It was seen that 58.08% of the study group, with a mean age of 30.5 years, were between the ages of 21 and 40. Males accounted for 71.53% of the total, while 252 individuals were female, giving a M: F ratio of 2.5:1. The prevalence of incidental mesenteric lymphadenopathy was 12.5%. Associated factors of Incidental Mesenteric Lymphadenopathy in this study were HIV, smoking, nomadic pastoralism, and surgical indication. HIV-positive patients were 7 times more likely to have IML with a 95% CI [2.975, 16.741], and ( p  < .0001), smokers were 10 times more likely to have IMLN, 95% CI [3.745, 28.458], and ( p  < .0001), nomadic pastoralists were 3 times more likely to have IMLN, 95% CI [1.647, 5.882], and ( p  < .0001) and patients who were operated upon peritonitis were 3 times more likely to have IMLN, 95% CI [2.040, 7.572], and ( p  < .0001). Of the incidental lymphadenopathy ( N  = 111), 23.42% had granulomatous tuberculous lesions, and 9.01% of lymph nodes harbored malignancy. About 47% of patients had histologically confirmed reactive lymph nodes, while 20.72% had an inflammatory pattern. Conclusion and recommendation The major factors associated with incidental enlarged mesenteric lymph nodes are smoking, comorbidities such as HIV and diabetes, malignancies, and infections such as tuberculosis. The common histological pattern is reactive nodes though there are potentially fatal nodes that were discovered including those that harbored malignancies and infections such as Tuberculosis. Therefore, to rule out potentially fatal illnesses and comorbidities that can be treated early to spare patients from extended hospital stays and potentially disastrous results, comprehensive investigations should be conducted in the event of incidentally enlarged mesenteric lymph nodes are found during a laparotomy.