Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is common in young Asian women under the age of 30, and is usually characterized by fever, myalgia, fatigue, and cervical lymphadenopathy. Because patients with KFD often present with necrotic lesions that are also features of lymph node metastasis, ipsilateral or bilateral lymph node enlargement in head and neck cancer patients can be disguised as lymph node metastasis. We present an unusual case of KFD mimicking bilateral metastatic papillary carcinoma of the thyroid. This study emphasizes that KFD should be considered when diagnosing lymph nodes with necrotic lesions but without malignant cells in young women.

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

Ischemic stroke is one of the manifestations of reversible cerebral vasoconstriction syndrome (RCVS). Many precipitants and associated disorders of RCVS have been suggested. However, few case reports have indicated an association between anemia and RCVS. Here, we report a case of a 66-year-old female with severe iron deficiency anemia (IDA), who presented with ischemic stroke and cerebral vasoconstriction, which gradually improved with conservative treatment. High-resolution vessel wall magnetic resonance imaging findings and reversibility suggested the possibility of RCVS. In patients with RCVS and ischemic stroke, IDA should be considered. Prompt management should be delivered to prevent disease progression and recurrence.

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

Purpose: To report a case of transient cortical blindness following cervical transforaminal epidural injection.Case summary: A 58-year-old diabetic and hypertensive male was referred to the ophthalmology department with sudden-onset bilateral visual disturbances after cervical transforaminal epidural injection for neck pain. During the procedure, an intravascular contrast medium was injected into the left vertebral artery. Immediately after the injection, the patient complained of bilateral visual disturbances, mild headache, and dizziness. Twelve hours after the procedure, his visual acuity was reduced to hand motion perception in both eyes. Anterior segment and fundus examinations were unremarkable. Pupillary light reflexes and extraocular muscle movements were normal. Brain magnetic resonance imaging, magnetic resonance angiography, and fluorescein angiography showed no significant findings. There were no other neurological abnormalities. The patient was treated conservatively with intravenous dexamethasone and nimodipine based on a provisional diagnosis of transient cortical blindness. The symptoms gradually improved 2 days after the procedure; visual acuity recovered to 20/20 by the third day. Conclusions Although contrast-induced transient cortical blindness is rare, it should be considered in patients with bilateral visual loss after transforaminal epidural injection. It is a benign and reversible condition but requires a prompt diagnosis.

Papillary thyroid carcinoma (PTC) is commonly accompanied by cervical lymph node metastasis, whereas metastases to the retropharyngeal lymph nodes (RPN) are rare. Radioactive iodine (RAI) ablation is recommended for detection and treatment of differentiated thyroid carcinoma (DTC). However, in some cases of iodine-negative DTC, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can aid in detection of additional lesions. We report on a patient with PTC who had retropharyngeal node involvement with iodine-negative features and low thyroglobulin level at the time of diagnosis but with metastasis identified on FDG PET/CT.
Diagnosis ; Electrons ; Humans ; Iodine ; Lymph Nodes ; Neoplasm Metastasis* ; Positron-Emission Tomography and Computed Tomography* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

OBJECTIVE: To investigate CT and 18F-flurodeoxyglucose (18F-FDG) positron-emission tomography/CT findings of primary endobronchial marginal zone B-cell lymphoma of the bronchus-associated lymphoid tissue (BALT). MATERIALS AND METHODS: From June 2006 through April 2012, seven patients (six female, one male; age range, 21-61 years; mean age, 49 years) were examined who were pathologically diagnosed with the primary endobronchial marginal zone B-cell lymphoma of BALT. We evaluated the locations and characteristics of the lesions on CT and 18F-FDG-PET/CT scans. The lesions were classified into the following three patterns: 1) solitary intraluminal nodule; 2) several tiny nodular protrusions; and 3) diffuse wall thickening. RESULTS: A solitary intraluminal nodule was observed in four patients (57.1%), several tiny nodular protrusion in two patients (28.6%), and diffuse wall thickening in one patient (14.3%). The lesions were categorized into 3 major locations: confined to the trachea (n = 3), confined to the lobar bronchus (n = 2), and diffuse involvement of the trachea and both main bronchi (n = 2). All lesions demonstrated homogeneous iso-attenuation as compared with muscle on pre- and post-enhancement scans. Secondary findings in the lungs (n = 3; 42.9%) included postobstructive lobar atelectasis (n = 1), air trapping (n = 1), and pneumonia (n = 1). On 18F-FDG-PET/CT (n = 5), 4 lesions showed homogeneous uptake with maximum standardized uptake values (mSUV), ranging 2.3-5.7 (mean mSUV: 3.3). One lesion showed little FDG uptake. CONCLUSION: Primary endobronchial marginal zone B-cell lymphoma of the BALT manifests as three distinct patterns on CT, with the solitary intraluminal nodule presenting as the main pattern. Most lesions demonstrate homogeneous but weak FDG uptake on 18F-FDG-PET/CT.
Adult ; Biopsy ; Bronchi/pathology ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Immunohistochemistry ; Lymphoid Tissue/pathology ; Lymphoma, B-Cell, Marginal Zone/pathology/*radiography/radionuclide imaging ; Male ; Middle Aged ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

Purpose: The aim of this multicenter study was to investigate the malignancy risk of minimally cystic thyroid nodules (MCTNs) using cyto-histopathologic diagnoses as the reference standard. Methods: From June 2015 to September 2015, 5,601 thyroid nodules (≥1 cm) from 4,989 consecutive patients who underwent thyroid ultrasonography (US) at 26 institutions were retrospectively analyzed. Each thyroid nodule was categorized according to its cystic proportion: purely solid, minimally cystic (≤10%), and partially cystic (>10%). The malignancy risk of MCTNs was compared with those of purely solid nodules and partially cystic thyroid nodules (PCTNs). The malignancy risk of MCTNs was assessed according to echogenicity and the presence of suspicious US features. Results: The prevalence of MCTNs was 22.5%. The overall malignancy risk of MCTNs was 8.8%, which was significantly lower than that of purely solid nodules (29.5%) (P<0.001), and slightly higher than that of PCTNs (6.2%) (P=0.013). The risk of malignancy associated with MCTNs was similar to that of PCTNs regardless of echogenicity or the presence of suspicious US features (all P>0.05). MCTNs were associated with a higher risk of malignancy in hypoechoic nodules than in isohyperechoic nodules and in nodules with suspicious US features than in those without suspicious US features (all P<0.001). Conclusion The malignancy risk of MCTNs was significantly lower than that of purely solid nodules. MCTNs could be categorized as PCTNs rather than as solid nodules to increase the accuracy of the risk stratification system for thyroid nodules.

OBJECTIVE: To identify superior cervical sympathetic ganglion (SCSG) and describe their characteristic MR appearance using 3T-MRI. MATERIALS AND METHODS: In this prospective study, we recruited 53 consecutive patients without history of head and neck irradiation. Using anatomic location based on literature review, both sides of the neck were evaluated to identify SCSGs in consensus. SCSGs were divided into definite (medial to internal carotid artery [ICA] and lateral to longus capitis muscle [LCM]) and probable SCSGs based on relative location to ICA and LCM. Two readers evaluated signal characteristics including intraganglionic hypointensity of all SCSGs and relative location of probable SCSGs. Interrater and intrarater agreements were quantified using unweighted kappa. RESULTS: Ninety-one neck sites in 53 patients were evaluated after exclusion of 15 neck sites with pathology. Definite SCSGs were identified at 66 (73%) sites, and probable SCSGs were found in 25 (27%). Probable SCSGs were located anterior to LCM in 16 (18%), lateral to ICA in 6 (7%), and posterior to ICA in 3 (3%). Intraganglionic hypointensity was identified in 82 (90%) on contrast-enhanced fat-suppressed T1-weighted images. There was no statistical difference in the relative location between definite and probable SCSGs of the right and left sides with intragnalionic hypointensity on difference pulse sequences. Interrater and intrarater agreements on the location and intraganglionic hypointensity were excellent (κ-value, 0.749-1.000). CONCLUSION: 3T-MRI identified definite SCSGs at 73% of neck sites and varied location of the remaining SCSGs. Intraganglionic hypointensity was a characteristic feature of SCSGs.
Carotid Artery, Internal ; Consensus ; Ganglia ; Ganglia, Sympathetic* ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Pathology ; Prospective Studies