American Journal of Case Reports最新文献

{"title":"Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.","authors":"Jinzhe Wang, Li Wei, Yufei Wang","doi":"10.12659/AJCR.953317","DOIUrl":"10.12659/AJCR.953317","url":null,"abstract":"<p><p>BACKGROUND Primary pelvic schwannomas are rare and often misdiagnosed due to non-specific imaging features. Accurate preoperative evaluation remains a challenge. The clinical utility of contrast-enhanced ultrasound (CEUS) combined with time-intensity curve (TIC) analysis and targeted biopsy was evaluated for the preoperative diagnosis and management of a pelvic schwannoma. CASE REPORT A 66-year-old man presented with dysuria and lumbago. Imaging revealed a large, mixed cystic-solid pelvic mass. Conventional ultrasound demonstrated a predominantly cystic-solid lesion with limited Doppler flow, whereas CEUS showed progressive dendritic enhancement of the viable solid component from the periphery toward the center, with non-enhancement of cystic or necrotic areas. TIC analysis demonstrated a distinctive \"equal-in and slow-out\" perfusion pattern, supported by quantitative parameters (rise time, time to peak, fall time, and washout area under the curve). Based on these perfusion characteristics, ultrasound-guided biopsy was directed toward hyperenhanced viable regions while avoiding necrotic zones, thereby improving tissue sampling accuracy. Immunohistochemistry confirmed S-100 and SOX-10 positivity, establishing a definitive diagnosis. Complete surgical resection with bladder defect repair was performed. Postoperatively, urinary function recovered, and no recurrent urinary or pelvic symptoms were reported during outpatient follow-up. CONCLUSIONS Quantitative CEUS-TIC analysis combined with targeted biopsy provides an effective preoperative diagnostic strategy for pelvic schwannomas. The observed CEUS-TIC perfusion pattern may correspond to the heterogeneous microvascular distribution of Antoni A and Antoni B regions; however, this hypothesis requires validation in future imaging-pathology correlation studies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953317"},"PeriodicalIF":0.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Integrated Approach to MSI-High Colorectal Cancer Therapy in a Young Patient: A Clinical Case.","authors":"Innara Turkpenova, Kaldygul Smagulova, Abay Jumanov, Aisha Moldasheva, Rabiga Kadyrbayeva, Azhar Imanaliyeva","doi":"10.12659/AJCR.953248","DOIUrl":"10.12659/AJCR.953248","url":null,"abstract":"<p><p>BACKGROUND Colorectal cancer (CRC) is extremely rare in adolescents and often presents with advanced disease because of nonspecific symptoms. Deficient mismatch repair (dMMR) and microsatellite instability-high (MSI-H) are important biomarkers that influence prognosis, treatment selection, and the need for genetic evaluation. We report the case of an adolescent with MSI-H-associated CRC presenting with acute intestinal obstruction. CASE REPORT A 16-year-old male initially underwent appendectomy for presumed acute appendicitis. Persistent postoperative bowel obstruction prompted computed tomography (CT), revealing a descending colon tumor requiring emergency Hartmann's procedure. Histopathology demonstrated mucinous adenocarcinoma, pT4N0M0, with vascular invasion. Immunohistochemistry showed loss of MSH2/MSH6 expression with retained MLH1/PMS2, indicating dMMR and findings highly suggestive of Lynch syndrome, although germline testing was unavailable. Molecular analysis identified a KRAS mutation without NRAS alterations. Given his multiple high-risk features, including T4 disease, bowel obstruction, vascular invasion, mucinous histology, and very young age, he received 12 cycles of adjuvant FOLFOX chemotherapy. Treatment was well tolerated, and he remains disease-free more than 5 years after completion of therapy. CONCLUSIONS This case highlights the diagnostic complexity of adolescent CRC and the need to consider colorectal malignancy in young patients with persistent or atypical abdominal symptoms. Routine MMR/MSI testing and comprehensive molecular profiling are essential in young-onset CRC to identify patients who may have hereditary cancer syndromes and require genetic counseling. Although limited to a single case, this report underscores the importance of multidisciplinary decision-making and individualized treatment based on clinicopathological and molecular characteristics, which may contribute to favorable long-term outcomes.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953248"},"PeriodicalIF":0.8,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Carinal Chondrosarcoma: Resection of the Main Carina, Distal Trachea, and Orifices of the Mainstem Bronchi and Construction of a New Carina.","authors":"Dimitrios I Viskos, Ioannis P Pantazis, Fotios F Danglis, Jubrail I Dahabreh","doi":"10.12659/AJCR.953333","DOIUrl":"10.12659/AJCR.953333","url":null,"abstract":"<p><p>BACKGROUND Chondrosarcoma of the trachea is an extremely rare malignancy, and tumors located at the main carina are even rarer. Carinal resection and subsequent reconstruction of a new carina constitute a demanding surgical procedure that requires extensive expertise and close collaboration between the anesthetic and surgical teams. In this case report, we aim to highlight the rarity of chondrosarcoma of the main carina and emphasize the critical role of surgical intervention despite the complexity of the procedure. Furthermore, we aim to share our clinical experience and contribute an additional case to the limited literature. CASE REPORT A 23-year-old man presented with dyspnea, fatigue, and cough. Chest computed tomography showed a lobulated soft-tissue mass anterior to the distal trachea and main carina. Fiberoptic bronchoscopy revealed widening of the main carina, clinically significant stenosis of the mainstem bronchi, and mucosal infiltration. Biopsy specimens obtained via mediastinoscopy demonstrated well-differentiated carinal chondrosarcoma. Through a right posterolateral thoracotomy, the distal trachea, main carina, and orifices of the mainstem bronchi were resected. A new carina was constructed and anastomosed to the distal trachea. Gross examination of the surgical specimen showed a well-circumscribed mass with a lobulated external surface measuring 7×6.5×5 cm. The patient remains well 17 years after tumor resection, without signs of recurrence. CONCLUSIONS Chondrosarcoma involving the distal trachea and main carina is an extremely rare tumor. Given the limited efficacy of chemotherapy and radiotherapy, surgical resection with reconstruction of a new carina is the primary treatment.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953333"},"PeriodicalIF":0.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Intermammary Breast Carcinoma Presenting With Direct Sternal Invasion: A Diagnostic Pitfall of Standard Screening Mammography.","authors":"Rachel Deming, Michael Fei, Harsha Choudary Pudhota, Sonal P Haerter, Moustafa Hazin","doi":"10.12659/AJCR.953831","DOIUrl":"10.12659/AJCR.953831","url":null,"abstract":"<p><p>BACKGROUND Standard screening mammogram views focus on the lateral and posterior breast tissues; the view that best visualizes the intermammary area, the 90-degree lateral or cleavage view, is not typically performed. The limited field of view of mammogram increases the importance of additional imaging with CT, ultrasound, and MRI as a tool in diagnosing neoplasm in the intermammary area. To date, intermammary primary breast carcinoma has been reported only a few times in the literature, and none of these described direct sternal invasion at presentation. CASE REPORT An 85-year-old woman with a past medical history of follicular non-Hodgkin lymphoma treated with bendamustine-rituximab in 2017 (without chest radiation) and significant family history of breast cancer presented to our clinic 2 months after noticing a hard, non-tender nodule on her sternum. She had undergone a routine screening mammogram 8 months prior, which was unremarkable. Subsequent diagnostic workup including targeted ultrasound, and PET-CT identified a hypermetabolic presternal mass. Notably, diagnostic mammography 8 months after the initial screening mammogram also failed to properly visualize the lesion. Biopsy confirmed ER+/PR+, HER2- adenocarcinoma consistent with breast origin. Despite negative initial staging for distant metastasis, pathological examination after resection revealed direct invasion into the sternum, necessitating partial sternectomy. CONCLUSIONS This case highlights a rare intermammary presentation of breast carcinoma with direct sternal invasion, a feature not previously reported. It emphasizes the blind spot of standard screening mammography in the medial breast/cleavage area and the necessity of targeted imaging for palpable parasternal masses, even in the setting of recent negative screens.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953831"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behind the Sella: A Rare Case of Pituicytoma Mimicking a Pituitary Adenoma.","authors":"Katarzyna Wołos-Kłosowicz, Nina Suligowska-Wolszczuk, Michał Szklarz, Joanna Rutkowska, Wojciech Matuszewski","doi":"10.12659/AJCR.953658","DOIUrl":"10.12659/AJCR.953658","url":null,"abstract":"<p><p>BACKGROUND Pituicytoma is a rare central nervous system (CNS) World Health Organization (WHO) grade I glioma originating from pituicytes, the specialized glial cells of the neurohypophysis or infundibulum. It accounts for less than 0.1% of all sellar and suprasellar masses and often presents a diagnostic challenge because of its clinical and radiological resemblance to other pituitary lesions. CASE REPORT A 48-year-old man was admitted to the endocrinology clinic because of clinical symptoms of hypogonadism, headaches, and visual field defects. Hormonal evaluation revealed hypogonadotropic hypogonadism and hyperprolactinemia. Magnetic resonance imaging (MRI) demonstrated a sellar-suprasellar mass, initially suggestive of prolactinoma. Lack of response to initial hormone replacement therapy, progressive tumor enlargement, and worsening visual impairment, prompted surgical resection via a right-temporal craniotomy. Histopathological and immunohistochemical examination established the diagnosis of pituicytoma (CNS WHO Grade 1). The postoperative course was complicated by transient cognitive impairment and endocrine deficiencies requiring long-term hormonal replacement therapy. We also review the epidemiology, clinical presentation, and current therapeutic approaches for this uncommon tumor. CONCLUSIONS Pituicytoma is a rare benign tumor that may closely mimic pituitary adenoma, both clinically and radiologically. Clinical manifestations are non-specific and primarily reflect tumor size and local extension. MRI findings are not pathognomic, making histopathological confirmation essential. Surgical resection remains the treatment of choice, whereas radiotherapy may be considered after subtotal resection. The case underscores the importance of recognizing hyperprolactinemia secondary to pituitary stalk compression, careful endocrine interpretation, individualized surgical planning, and prolonged multidisciplinary follow-up, given the uncertain long-term prognosis and potential endocrine sequelae.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953658"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Volume Superior Trunk and Superficial Cervical Plexus Block With Sedation as the Sole Regional Anesthetic for Proximal Humerus Fracture Fixation in a Patient With Alzheimer Disease.","authors":"Niruji Saengsomsuan, Lalida Sangkakit","doi":"10.12659/AJCR.954296","DOIUrl":"10.12659/AJCR.954296","url":null,"abstract":"<p><p>BACKGROUND Proximal humerus open reduction and internal fixation (ORIF) is usually performed under interscalene brachial plexus block (ISB) or general anesthesia (GA). ISB causes ipsilateral phrenic nerve paresis in nearly all patients, and GA may raise the risk of postoperative neurocognitive disorders in elderly patients with cognitive impairment. We report the feasibility of a low-volume regional technique, used as the sole regional anesthetic with sedation, in a patient in whom GA avoidance was desirable. CASE REPORT A 68-year-old woman (American Society of Anesthesiologists physical status II) with Alzheimer's disease underwent ORIF of a closed right proximal humerus fracture via a deltopectoral approach under superior trunk block (STB) with 5 mL of 0.5% bupivacaine, combined with superficial cervical plexus block (SCPB) with 3 mL of 0.5% bupivacaine, totaling 8 mL, with propofol and dexmedetomidine sedation. Surgery lasted 174 minutes without intraoperative rescue analgesia. Heart rate ranged from 48 to 68 beats/min during dexmedetomidine infusion without anticholinergic treatment, and oxygen saturation remained at 100% with spontaneous ventilation preserved. The block provided analgesia for about 12 hours, with pain score 1/10 at rest at 24 hours, and satisfaction 10/10. No clinically evident respiratory compromise, Horner's syndrome, or postoperative delirium was observed, although diaphragmatic and cognitive function were not formally assessed. The patient was discharged on postoperative day 2. CONCLUSIONS In this single patient, low-volume STB combined with SCPB was a feasible sole regional anesthetic technique, supported by sedation, for proximal humerus ORIF, completed without conversion to GA or clinically evident respiratory compromise. Respiratory and cognitive outcomes were clinically uneventful but not formally measured; broader utility remains to be established.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954296"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Peritoneal Loose Body Discovered During Laparoscopic Varicocelectomy: A Case Report.","authors":"Jad K Alsmadi, Anas A Al-Bdour, Ahmad F Abuo'waida","doi":"10.12659/AJCR.954629","DOIUrl":"10.12659/AJCR.954629","url":null,"abstract":"<p><p>BACKGROUND Peritoneal loose bodies (PLBs) are rare, benign intraperitoneal entities usually discovered incidentally during abdominal surgery or imaging. Their occurrence during urologic laparoscopy appears to be infrequently reported and may create intraoperative diagnostic uncertainty when encountered unexpectedly. CASE REPORT A healthy 22-year-old Jordanian man with no history of abdominal or pelvic surgery underwent bilateral laparoscopic varicocelectomy for symptomatic varicoceles. Dense sigmoid adhesions over the left internal inguinal ring required careful adhesiolysis to expose the spermatic vessels. During dissection, a smooth, freely mobile ovoid structure was identified within the left paracolic gutter and retrieved laparoscopically. Histopathological examination demonstrated necrotic adipose tissue with dystrophic calcification, confirming a PLB. The patient recovered uneventfully and reported resolution of his preoperative symptoms at the 3-week postoperative follow-up. CONCLUSIONS This report highlights that a PLB may be encountered unexpectedly even in a healthy patient with no history of abdominal or pelvic surgery who is undergoing an elective, limited-field laparoscopic urologic procedure. In the present case, the lesion's smooth surface, complete mobility, lack of visible vascular attachment, and firm, rubbery consistency supported intraoperative consideration of a benign PLB. This observation supports awareness that a similar freely mobile, avascular intraperitoneal body encountered unexpectedly during laparoscopy may represent a benign PLB; however, broader management implications cannot be established from a single case. Histopathological confirmation remains important when the diagnosis is uncertain.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954629"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Kidney Transplantation Under Combined Spinal-Epidural Anesthesia in a Patient With a History of Left Pneumonectomy Due to Bronchiectasis.","authors":"Merve Aktar, Adem Tunçer, Selda Karagöz, Hande İkitimur","doi":"10.12659/AJCR.953539","DOIUrl":"10.12659/AJCR.953539","url":null,"abstract":"<p><p>BACKGROUND Kidney transplantation offers clear survival and quality-of-life advantages over dialysis, but severe pulmonary disease can complicate perioperative planning. In patients with substantially reduced respiratory reserve after pneumonectomy, general anesthesia may be considered high risk, creating uncertainty about transplant feasibility. CASE REPORT A 33-year-old man with end-stage kidney disease secondary to biopsy-proven AA amyloidosis was evaluated for preemptive living-donor kidney transplantation. He had undergone left pneumonectomy in 2015 because of bronchiectasis. Pulmonary function testing showed a mixed restrictive-obstructive pattern, with a forced vital capacity of 1.6 L (33% predicted), a forced expiratory volume in 1 second of 1.05 L (30% predicted), and a forced expiratory volume in 1 second/forced vital capacity ratio of 65%, indicating severe pulmonary impairment. Thoracic computed tomography demonstrated leftward mediastinal shift and diffuse bronchiectatic changes in the remaining right lung. Given the anticipated risk associated with general anesthesia, combined spinal-epidural anesthesia was selected. The transplant was successfully performed using a kidney from the patient's human leukocyte antigen (HLA)-identical sister. No intraoperative respiratory or hemodynamic instability occurred. Renal function rapidly improved after surgery: serum creatinine decreased from 6.6 mg/dL preoperatively to 0.63 mg/dL on postoperative day 3. Heavy proteinuria also greatly improved during follow-up. CONCLUSIONS This case demonstrates that kidney transplantation can be successfully performed under combined spinal-epidural anesthesia in carefully selected patients with severely limited pulmonary reserve after pneumonectomy. It also highlights the importance of individualized anesthetic planning and close multidisciplinary coordination for complex transplant candidates with major pulmonary comorbidities.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953539"},"PeriodicalIF":0.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life-Threatening Ventricular Tachycardia and Transient Brugada-Like Electrocardiographic Abnormalities Caused by Severe Hyperkalemia Due to Urinary Retention in a 55-Year-Old Man.","authors":"Yoshiyasu Aizawa, Tomoko S Kato, Akio Kawamura","doi":"10.12659/AJCR.954530","DOIUrl":"10.12659/AJCR.954530","url":null,"abstract":"<p><p>BACKGROUND Hyperkalemia is a potentially fatal electrolyte disturbance that typically manifests as progressive conduction abnormalities, bradyarrhythmias, and sine-wave electrocardiographic changes. In rare cases, however, severe hyperkalemia also presents with malignant ventricular tachyarrhythmias and transient electrocardiographic abnormalities involving the right precordial leads, potentially leading to diagnostic confusion with primary arrhythmic disorders. CASE REPORT A 55-year-old man with no known cardiovascular disease presented with palpitations, dyspnea, and diaphoresis. Electrocardiography demonstrated sustained wide-QRS ventricular tachycardia accompanied by hemodynamic instability. Following electrical cardioversion, recurrent ventricular tachyarrhythmias occurred, requiring repeated defibrillation, cardiopulmonary resuscitation, intravenous amiodarone, and mechanical ventilation. Laboratory testing revealed severe hyperkalemia (7.6 mmol/L), profound metabolic acidosis (pH 7.059, HCO₃⁻ 13.8 mmol/L), and advanced renal dysfunction. Serum potassium was confirmed on repeat testing. Subsequent electrocardiography demonstrated marked QRS widening, terminal conduction delay, and transient right precordial ST-segment abnormalities involving leads V1-V2. Intravenous calcium gluconate and sodium bicarbonate rapidly improved the electrocardiographic abnormalities. Continuous hemodiafiltration and bladder catheterization were performed after postrenal acute kidney injury caused by urinary retention was identified. Correction of hyperkalemia together with treatment of metabolic acidosis resulted in complete resolution of the ventricular arrhythmias and electrocardiographic abnormalities without recurrence. No evidence of structural heart disease or persistent myocardial ischemia was identified during subsequent evaluation. CONCLUSIONS This case illustrates that severe hyperkalemia secondary to reversible postrenal acute kidney injury can simultaneously present with malignant ventricular tachyarrhythmia and transient electrocardiographic abnormalities. Recognition of this reversible metabolic condition is essential to avoid diagnostic error and facilitate prompt life-saving treatment.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954530"},"PeriodicalIF":0.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hodgkin Lymphoma With Sarcoid-Like Reaction: Importance of Clinicopathological Correlation in Granulomatous Lymphadenopathy.","authors":"Ryosuke Fujita, Shiro Ono, Sota Sakamoto, Hiroyuki Taguchi, Satoshi Senzaki, Ayaka Kakiwaki, Nobushiro Nishimura, Ryo Yoneima, Masaki Matsubara, Takayoshi Morita, Noritaka Yada, Kiyomi Yoshimoto","doi":"10.12659/AJCR.954572","DOIUrl":"10.12659/AJCR.954572","url":null,"abstract":"<p><p>BACKGROUND Sarcoid-like reaction, characterized by noncaseating epithelioid granulomas, occurs in 13.8% of Hodgkin lymphoma cases. When the granulomatous component is prominent and neoplastic cells are scarce, the initial biopsy may lead to a misdiagnosis of sarcoidosis. Reliance on pathological findings alone, without integration of the clinical context, can result in considerable diagnostic delay. CASE REPORT A 63-year-old man with systemic lymphadenopathy underwent cervical lymph node biopsy, which showed epithelioid granulomas without identifiable neoplastic cells. Sarcoidosis was initially suspected based on the pathological findings. However, comprehensive evaluation revealed no typical manifestations of sarcoidosis, including bilateral hilar lymphadenopathy, uveitis, or elevated serum angiotensin-converting enzyme levels. The discordance between the pathological diagnosis and clinical findings led us to retain malignant lymphoma in the differential diagnosis. During follow-up, the patient developed B symptoms with substantially elevated soluble interleukin-2 receptor levels. Repeat biopsy of the left supraclavicular lymph node, performed 7 months after the initial presentation, revealed Reed-Sternberg-like multinucleated cells surrounded by a sarcoid-like reaction, confirming classical Hodgkin lymphoma. CONCLUSIONS This case illustrates that pathological findings alone may be insufficient for a definitive diagnosis of granulomatous lymphadenopathy. Malignant lymphoma should remain in the differential diagnosis, even when the initial biopsy suggests sarcoidosis. When clinical features are inconsistent with the pathological diagnosis, clinicians should reconsider the differential diagnosis, and repeat biopsy may be warranted. Integration of clinical findings, imaging, and histopathology is important to avoid diagnostic delay.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954572"},"PeriodicalIF":0.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}