Jefferson Health Corp.

We aimed to investigate the race-related differences in clinical, radiological, and pathological presentation and prognosis of phyllodes tumors (PTs).

This retrospective cohort study included patients diagnosed with PTs from 5/1/2012 to 5/31/2022. Pathology reports, radiology findings, and clinical data were extracted from electronic medical records. Statistical analysis assessed these differences across racial demographics.

Among 62 women with PTs (mean age: 41 ± 15.2 years), the racial distribution was 21 % Caucasian, 32 % African American, 17.7 % Hispanic, and 29 % Asian/Other. Minority women were significantly more likely to present with palpable masses than Caucasian patients (p = 0.031), suggesting potential disparities in early detection. Minority patients were more likely to be covered by Medicaid and reside in lower-income ZIP codes, with a higher proportion under age 40 at presentation, though these results were not statistically significant. While tumor size varied by race, this difference was also not statistically significant (p = 0.094). Pathologically, 66.1 % of tumors were benign, 22.6 % borderline, and 11.3 % malignant. Although lumpectomy was the preferred approach across all racial groups, no Caucasian or Hispanic patients undergoing mastectomy. No significant racial differences were observed in resection margins (p = 0.263), re-excision rates (p = 0.503), or recurrence rates (p = 0.238).

Minority women had a higher likelihood of presenting with symptomatic PTs, underscoring potential disparities in screening. While treatment outcomes were similar across racial groups, targeted screening efforts in at-risk populations may improve early detection and promote equitable healthcare access.

Rheumatoid arthritis (RA) presents with extra-articular manifestations in 15–25% of cases. Intra-osseous rheumatoid nodules occur in <1% of patients and mimic metastatic disease on imaging. When extra-articular features precede joint symptoms, diagnostic delays are common.

A 78-year-old male smoker presented with chronic cough and dyspnea. CT revealed interstitial lung disease and a pulmonary nodule. PET-CT demonstrated multiple FDG-avid osteolytic lesions in ribs, scapula, and spine (SUV 4.2–8.7), suggesting metastatic malignancy. Initial biopsies showed inflammation without malignancy. Four months later, the patient developed polyarthralgia, morning stiffness, and 8-kg weight loss. Hand radiographs revealed erosive arthropathy. Laboratory tests showed rheumatoid factor 240 IU/mL, anti-CCP 185 U/mL, ESR 68 mm/hr, and CRP 42 mg/L. Repeat scapular biopsy identified necrobiotic granulomas consistent with rheumatoid nodules.

Intra-osseous rheumatoid nodules result from immune complex-mediated tissue necrosis. Inflammatory cytokines activate osteoclasts, creating lytic lesions with high metabolic activity indistinguishable from metastases on PET imaging. Extra-articular manifestations precede joint symptoms in 10–15% of RA cases. Anchoring bias toward malignancy in an elderly smoker with pulmonary nodules and osteolytic lesions delayed alternative diagnoses. Negative initial biopsies and subsequent development of erosive arthropathy prompted diagnostic reconsideration.

Extra-articular RA can masquerade as metastatic disease. Intra-osseous rheumatoid nodules represent rare manifestations requiring histological confirmation. Clinicians should consider systemic autoimmune diseases when evaluating unexplained interstitial lung disease with multiple osteolytic lesions, particularly when malignancy screening is negative. Early recognition enables appropriate immunosuppressive therapy and prevents irreversible organ damage.

Post-transfusion purpura (PTP) is a rare, immune-mediated disorder characterised by severe thrombocytopaenia occurring 5–12 days after a blood transfusion. It occurs in approximately from 1 out of 24 000 to 1 out of 100 000 transfusions. It occurs when the immune system attacks transfused platelets, particularly those with the human platelet antigen-1 a (HPA-1a), which the body recognises as foreign if the person has been previously exposed to it. This antigenic reaction is more likely in individuals with a history of pregnancies or transfusions involving platelets expressing HPA-1a. Patients who has anti-HPA- 1a antibodies after having being exposed to platelets which contains HPA-1a antigens following pregnancy or blood transfusion are at risk of PTP. The management of PTP typically involves transfusing platelets lacking this antigen, immunosuppression, plasmapheresis to remove antibodies and close monitoring. This case report highlights a rare and life-threatening complication of PTP—the first documented occurrence of diffuse alveolar haemorrhage (DAH) in an elderly patient with a remote history of immune thrombocytopaenic purpura. The patient developed respiratory distress, diffuse petechiae and profound thrombocytopaenia 8 days after receiving a blood transfusion for symptomatic chronic anaemia. A comprehensive diagnostic workup, including bronchoscopy, confirmed the presence of DAH. Prompt recognition and management, involving specialised blood products, immunosuppression and close monitoring, led to a successful outcome in this complex clinical scenario. This case underscores the challenges in diagnosing and managing PTP, especially in elderly patients with multiple comorbidities and a history of blood disorders. It highlights the critical importance of swift identification and intervention to prevent life-threatening complications in such patients.