Mousa Abeer,  Fox Lauren,  Simmons Curtis

Final Pr. ID: Poster #: CR-058

We present a case of an 11-year-old male with history of pars planitis (intermediate uveitis) on monthly infliximab and weekly methotrexate. The patient developed diffuse lymphadenopathy, predominantly in the head and neck region, raising suspicion for malignancy. CT of the neck and chest demonstrated enlarged cervical, upper mediastinal , and bilateral axillary lymph nodes. PET/CT confirmed prominent FDG uptake in these lymph nodes. A lymph node biopsy of a parotid lymph node confirmed Epstein Barr virus-positive polymorphic lymphoproliferative disorder in the setting of immune deficiency/dysregulation. Follow up PET/CT 2 months later after discontinuation of immunosuppressive therapy demonstrated significant improvement in size and radiotracer uptake of the enlarged lymph nodes. However within this time frame, the patient’s uveitis worsened. The patient is being followed by ophthalmology to explore other localized treatment options including steroid eye drops and steroid implants.
The majority of described findings in the radiology literature encompasses lymphoproliferative disorders in the setting of transplant (post-transplant lymphoproliferative disorder (PTLD)) or primary immunodeficiency. However, there is little in the way of lymphoproliferative disorders associated with immunosuppressive therapy. Most cases reported in the literature involve methotrexate use in adults with rheumatoid arthritis. Prior to 2022, this entity held a WHO classification entitled “other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OII-LPD)”. Following a 2022 WHO reclassification, both PTLD and OII-LPD are encompassed under the classification of “lymphoid proliferations and lymphomas associated with immune deficiency and dysregulation". Further research on imaging of OII-LPD would add to the existing literature and increase awareness of such an entity in the setting of immunosuppressive therapy. Read More

Authors:  Mousa Abeer , Fox Lauren , Simmons Curtis

Keywords:  Lymphoproliferative, PTLD, Lymphadenopathy

Kirihetti Liyanage Neelika,  Kumbla Surekha

Final Pr. ID: Poster #: EDU-001

Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality which affects transplant recipients of solid organs and allogenic bone marrow transplants. Paediatric recipients of organs that require high levels of immunosuppression are the most susceptible population. Incidence and the frequency of PTLD in paediatric age group is consistently higher than it is in adults. There is insufficient recent literature on imaging features of PTLD in the paediatric age group.
Our purpose is to illustrate multi-modality imaging characteristics of PTLD affecting different organs and systems in a cohort of paediatric patients with biopsy proven PTLD. Read More

Authors:  Kirihetti Liyanage Neelika , Kumbla Surekha

Keywords:  PTLD, Transplant, Lymphadenopathy

Laucis Nicholas,  True-malhotra Aisha,  Leschied Jessica

Final Pr. ID: Poster #: CR-019

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm presenting as a mass in the subcutis or deep dermis in the extremities of children and young adults. Although previously regarded as ‘malignant’, due to its benign microscopic appearance and favorable prognosis, this tumor was categorized as an “intermediate tumor of uncertain differentiation” in the 2013 World Health Organization classification.

AFH is often misdiagnosed on imaging and pathology. We will present the unusual case of AFH with extensive lymphadenopathy and multiple episodes of anemia. The imaging findings will be illustrated with radiographic, ultrasound, MRI, and PET/CT exams. We will also present gross specimen and pathology images.

Our case involves a 9 year old male presenting with asymptomatic left upper arm and left chest wall masses for two years. A previous biopsy of the mass and a lymph node had been performed, showing juvenile capillary hemangioma and benign progressive germinal transformation, respectively. The patient had several prior episodes of anemia requiring multiple blood transfusions. Coagulopathy workup was negative, and it was postulated that bleeding into the mass could be the source of the anemia.

Radiographs revealed a 4.5 cm ovoid mass in the posteromedial soft tissues of the upper left arm with stable size but increasing calcific serpiginous opacifications throughout the lesion compared to two years prior. Multiple round soft tissue nodules within the left axillary region were also present.

MRI revealed a heterogeneous lesion with a calcified rim with significant susceptibility artifact likely from hemosiderin. Several enlarged adjacent lymph nodes were present with additional marked lymphadenopathy filling the left axilla abutting the brachial plexus and neurovascular bundles, extending superiorly above the acromion. The largest lymph node measured 2.8 cm within a cluster of lymphadenopathy measuring 9 x 4 x 4 cm, increased compared to MRI two years prior. PET/CT revealed increased radiotracer uptake in the mass with a max SUV of 4.5 and within the left axillary lymphadenopathy with a max SUV of 6.5.

The patient underwent surgical excision of the mass with dissection and removal of two adjacent palpable lymph nodes. The mass had a firm capsule with a red/myxoid appearance measuring 6.0 x 5.0 cm. Pathology of the mass was consistent with angiomatoid fibrous histiocytoma and pathology of the lymph nodes revealed reactive follicular hyperplasia. Read More

Authors:  Laucis Nicholas , True-malhotra Aisha , Leschied Jessica

Keywords:  angiomatoid fibrous histiocytoma, lymphadenopathy, mass

Petrosyan Lilit,  Ayvazyan Sona

Final Pr. ID: Poster #: CR-008

Nasopharyngeal carcinoma (NPC) is a rare malignancy in the pediatric population, comprising less than 1% of all pediatric malignancies. NPC typically occurs in older children and adolescents, with the highest incidence between ages 10-19, and there may be a slight male predominance.
A 14-year-old boy presented with a 2-week history of earache, hearing loss, headache, fever, neck pain, and palpable enlarged lymph nodes in the neck. Ultrasound revealed bilateral cervical lymphadenitis. Upon physical examination, the throat appeared hyperemic. Blood tests showed moderately elevated inflammatory markers. Initially, the patient was diagnosed with cervical lymphadenitis, right-sided otitis, and eustachitis. Antibiotic therapy was initiated, resulting in mild improvement; however, the primary symptoms persisted.
Serological testing for Epstein-Barr virus (EBV) was negative. A contrast-enhanced CT scan was performed due to the suspicion of an abscess. The CT revealed a hypervascular mass measuring 4.3x3.3cm in the nasopharynx, extending into the parapharyngeal and retropharyngeal spaces from the right side, significantly narrowing the nasopharyngeal airway. Cervical lymphadenopathy was also noted, particularly on the right side.
Given the imaging findings, a differential diagnosis was considered between lymphoma and nasopharyngeal carcinoma. A pediatric oncology consultation was obtained, and biopsies of both the retropharyngeal mass and cervical lymph nodes were performed. Histopathological analysis confirmed the diagnosis of nasopharyngeal carcinoma.
Nasopharyngeal carcinoma in pediatric patients often presents with non-specific symptoms, contributing to diagnostic delays. Cervical lymphadenopathy is frequently the primary clinical finding, typically manifesting as painless enlarged neck lymph nodes. Other common symptoms include nasal obstruction, nasal discharge, and ear-related issues such as otitis media with effusion, hearing loss, or tinnitus due to eustachian tube dysfunction. In cases presenting with these symptoms, imaging with CT or MRI has an important role for early diagnosis. Read More

Authors:  Petrosyan Lilit , Ayvazyan Sona

Keywords:  Lymphadenopathy, Oncology, Paediatric Radiology

Navallas Maria,  Daneman Alan,  Amirabadi Afsaneh,  Wasserman Jonathan

Final Pr. ID: Poster #: SCI-067

To evaluate the diagnostic accuracy of US and the most useful sonographic features for diagnosing metastatic cervical adenopathy in pediatric patients with thyroid carcinoma Read More

Authors:  Navallas Maria , Daneman Alan , Amirabadi Afsaneh , Wasserman Jonathan

Keywords:  Thyroid carcinoma, cervical lymphadenopathy, ultrasound

Hwang Jisun,  Hwang Jae-yeon,  Moon Jayoung,  You Seulgi

Final Pr. ID: Poster #: SCI-036

To evaluate the diagnostic performance of ultrasound (US) features for differentiating malignant from benign cervical lymphadenopathy in children. Read More

Authors:  Hwang Jisun , Hwang Jae-yeon , Moon Jayoung , You Seulgi

Keywords:  Ultrasonography, Cervical Lymphadenopathy, Malignant

Baig Farhan,  Zapala Matthew,  Kim Jane,  Durand Rachelle,  Cohen Pierre-alain,  Wattier Rachel,  Courtier Jesse

Final Pr. ID: Poster #: EDU-058

Cat-Scratch Disease (CSD) is an infectious disease that predominantly affects pediatric patients, usually ages 4-9 years old. The annual incidence is estimated at 4.5 patients per 100,000 population. CSD is primarily caused by B. henselae, an intracellular gram-negative bacillus; it is transmitted via scratch, lick, or bite from a cat. It presents with lymphadenopathy proximal to the site of inoculation; most commonly, this is axillary, epitrochlear, cervical, or inguinal lymphadenopathy. While CSD can be diagnosed clinically and has objective findings on histopathology, the imaging findings are unclear and have been debated in the literature. As such, we sought to clarify the multimodal imaging findings associated with CSD. We performed a review of the literature to highlight the existing radiological consensus. We also contribute several of our own new cases from our institution. Read More

Authors:  Baig Farhan , Zapala Matthew , Kim Jane , Durand Rachelle , Cohen Pierre-alain , Wattier Rachel , Courtier Jesse

Keywords:  Cat Scratch Disease, CSD, lymphadenopathy

Lucin Michael,  Faruqui Sami,  Watal Pankaj,  Sato Yutaka,  Price Nathan,  Sato T Shawn

Final Pr. ID: Poster #: EDU-096

In the pediatric population, lymphadenopathy may be caused by a variety of diseases including lymphoma. Accurate differentiation of a non-lymphomatous lymphoproliferative disorder from lymphoma and other lymphoproliferative disorders is important in determining appropriate management. Radiologic imaging including assessment of cervical, mediastinal, and hilar lymphadenopathy can often provide the critical clue needed for accurate diagnosis. Read More

Authors:  Lucin Michael , Faruqui Sami , Watal Pankaj , Sato Yutaka , Price Nathan , Sato T Shawn

Keywords:  Lymphadenopathy, Lymphoproliferative

Sandigo Saballos Isabela,  Arguello Fletes Gladys,  Fenton Laura

Final Pr. ID: Poster #: CR-002

Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a benign, self-limited disorder, associated with B symptoms (fever, weight loss) and painful lymphadenopathy. The combination of lymphadenopathy with B symptoms in the pediatric population raises suspicion for malignant diseases such as lymphoma, neuroblastoma, and rhabdomyosarcoma. We evaluated a series of children with biopsy-proven histiocytic necrotizing lymphadenitis to assess for unique imaging characteristics. Read More

Authors:  Sandigo Saballos Isabela , Arguello Fletes Gladys , Fenton Laura

Keywords:  Benign causes of lymphadenopathy, CT Perinodal infiltration and necrosis, CT Nodal Necrosis