Objective: Rare disease Background: Appendicitis is the most common cause of an acute abdomen. Approximately 1% of appendicectomies will have an incidental finding of an appendiceal neoplasm. A primary appendiceal lymphoma is extremely rare, and is found in 0.015% of all appendiceal specimens. Burkitt lymphoma is an aggressive B cell lymphoma characterized by translocation and dysregulation of the c-Myc gene. Burkitt leukemia is considered to be an alternative manifestation of the same pathology, and is defined by the presence of >25% Burkitt blasts within the bone marrow. The treatment approaches for Burkitt leukemia/lymphoma are similar. Case Report: A 6-year old girl presented with a history, examination, and radiological imaging consistent with acute appendicitis. An inflamed, edematous appendix was identified intraoperatively, and a cecectomy was performed. Histopathological investigations demonstrated Burkitt leukemia with isolated extra-nodal involvement of the appendix. The patient was subsequently started on a multi-agent steroid and chemotherapy regimen. A literature review was performed, identifying cases of Burkitt leukemia/lymphoma presenting as appendicitis. Conclusions: This case highlights the importance of clinical vigilance and routine specimen histopathology review, and explores key management considerations associated with the incidental diagnosis of Burkitt leukemia/lymphoma.
A prospective study was conducted to assess the value of surgeon-performed ultrasound (SUS) in primary hyperparathyroidism. A total of 204 consecutive patients were studied prospectively with surgeon performed neck ultrasound. The results were compared with sestamibi nuclear scintigraphy (SNS) and radiologist-performed ultrasound (RUS) and correlated with the operative findings. SUS was true positive in 173 of 204 (85%), false positive in two (1%), false negative in 23 (11%), and true negative in six (2.5%) in patients, where the gland was inaccessible by US (sensitivity 88%, PPV 98%). SNS was true positive in 126 of 188 (67%), false positive in 3%, and false negative in 30% (sensitivity 69%, PPV 95%). RUS was true positive in 57 of 139 (40%), false positive in 5%, false negative in 52% and true negative in 3% (sensitivity 43%, PPV 89%). Comparing correct localization with incorrect localization by the Fisher's exact test, SUS was superior to SNS (p < 0.0001) and to RUS (p < 0.0001). 116 patients had bilateral neck exploration and 88 had open focused minimally invasive surgery. Five percent had multigland disease and 97% were cured after one operation. SUS was the only imaging modality in 16 patients and was sufficiently convincing to allow minimally invasive parathyroidectomy in eight. Surgeons treating hyperparathyroidism should find SUS a valuable tool. In our experience, SUS was more accurate than RUS whose costeffectiveness is questionable.
HighlightsOccult thyroid cancer may present as nodal metastases mimicking benign disease.A comprehensive workup of any neck lump is essential to exclude sinister pathology.Early MDT involvement is vital when there is a lack of widely accepted guidelines.
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