VG Med IF b79818-02b01 lymph nodes mesentery massive enlarged sandwich sign T Cell Lymphoma CT lymph nodes mesentery massive enlarged sandwich sign T Cell Lymphoma CT 51F abdominal pain

51-year-old female with abdominal pain

Part A — Questions

Q1. Major finding(s) visible in the image (select all that apply):

1 Retroperitoneal adenopathy
2 Mesenteric adenopathy
3 Sandwich sign
4 Thickened bowel wall

Q2. Associated finding(s) related to the major finding:

1 Hemorrhagic Renal Cysts
2 Solid renal masses
3 Ascites
4 Hepatic cysts likely incidental

Additional Information
see below

2. Findings

Radiological Findings

Systemic Lymphoma: The “Sandwich Sign”
Axial CT images (a, c) with magnified views (b, d) demonstrate extensive and massive mesenteric adenopathy (white asterisks) and retroperitoneal lymphadenopathy (white arrowheads). Despite the bulk of the disease, the mesenteric blood vessels are encased by the soft tissue mass without significant occlusion, creating the classic “sandwich sign.” Associated findings include bilateral solid renal masses (green arrowheads), ascites (yellow asterisks), and a benign hepatic cyst.
The disproportionately mild compression of vascular structures by such a large tumor volume is a key feature highly suggestive of lymphoma. The tumor’s characteristically soft and pliable consistency, often described pathologically as “fish flesh,” allows it to envelop structures rather than aggressively constricting them.
The constellation of massive mesenteric and retroperitoneal disease, the “sandwich sign,” discrete renal masses, and ascites confirms widespread systemic involvement. This presentation is highly characteristic of an advanced-stage, aggressive lymphoma.
Courtesy: Ashley Davidoff, MD | TheCommonVein.com (b79818-02b01Lb)

A) Answers Table

Q1. Major finding(s)
1 ☑ Retroperitoneal adenopathy
2 ☑ Mesenteric adenopathy
3 ☑ Sandwich sign
4 ☒ Thickened bowel wall

Q2. Associated finding(s)
1 ☒ Hemorrhagic Renal Cysts
2 ☑ Solid renal masses
3 ☑ Ascites
4 ☑ Hepatic cysts likely incidental

B) Findings Table

Title	Details
Mesenteric/Retroperitoneal Adenopathy	• Definition: Pathologic enlargement of lymph nodes located within the small bowel mesentery and the retroperitoneal space. • Comment: In this case, the adenopathy is massive and confluent, which is characteristic of a high-grade lymphoma. • Citation: (Perry, Radiographics 2018)
Sandwich Sign	• Definition: The encasement of mesenteric vessels by a confluent soft-tissue nodal mass, without significant vascular compression • Comment: This sign is highly suggestive of lymphoma due to the tumor’s soft consistency, allowing it to envelop rather than constrict vessels. • Citation: (Urban, Radiographics 1998)
Secondary Renal Lymphoma	• Definition: The involvement of the kidneys by lymphoma that originated elsewhere, typically presenting as multiple solid masses. • Comment: The kidneys are the most common site of extranodal hematologic spread in non-Hodgkin lymphoma. • Citation: (Sheth, Radiographics 2017)

Other Images from this Case Axillary Adenopathy And Right Breast Swelling

Systemic T-Cell Lymphoma with Massive Axillary Adenopathy
Axial images at the thoracic inlet (a) and lung bases (b), along with coronal (c) and sagittal (d) reformats, demonstrate extensive and massive lymphadenopathy in the right axilla (pink arrowheads). This has resulted in secondary edema and thickening of the skin of the right breast due to lymphatic obstruction (white arrowheads, b, d). Associated findings include a left pleural effusion (yellow arrowhead, b) and a small amount of ascites (orange arrowhead, c).
The dominant finding is the bulky nodal disease in the axilla. The breast edema is a direct mechanical consequence of this lymphatic blockage. The presence of fluid in both the chest (pleural effusion) and abdomen (ascites) confirms a widespread, systemic process consistent with the patient’s known diagnosis of T-cell leukemia/lymphoma.
This combination of massive nodal disease with secondary lymphatic obstruction and serous effusions is indicative of advanced-stage, high-grade lymphoma.
Courtesy Ashley Davidoff, MD | TheCommonVein.net (b79818-01L)

Renal Involvement

Cardiac Involvement

Cardiac T-Cell Lymphoma
Axial CT through the heart of a 51-year-old female who presented with palpitations and known history of T cell Lymphoma. The dominant finding is a nodule in the free wall of the left ventricle (LV) (magnified b red arrowhead). Associated findings include skin thickening of the right breast(white arrowhead), a small left pleural effusion (orange arrowhead), ascites, (yellow arrowhead) and multiple simple cysts in the liver.
Synthesizing the clinical presentation of palpitations with the imaging findings of a nodule in the heart abnormal right breast, and serous effusions (pleural and peritoneal) makes a diagnosis of cardiac lymphoma, specifically T-cell lymphoma, highly probable. The simple liver cysts are noted as incidental findings.
Courtesy Ashley Davidoff, MD | TheCommonVein.net (b79818-00L)

C) Comments

Comments
• Biopsy of an accessible mass (mesenteric or retroperitoneal) is required for definitive histopathological diagnosis.
• While highly suggestive of lymphoma, widespread metastatic disease can occasionally mimic this appearance.
• The simple hepatic cysts are benign and incidental, requiring no further follow-up in this clinical context.

D) Pearls

Pearls
• The “sandwich sign” results from lymphoma’s tendency to mold around structures (“fish flesh” consistency) rather than invade them.
• Multiple bilateral solid renal masses in an adult should always raise strong suspicion for either metastases or lymphoma.
• Despite the massive tumor bulk often seen, patients with aggressive lymphoma can have a dramatic and rapid response to chemotherapy.

3. Diagnosis

Section	Description
Definition	T-cell lymphomas are a rare and diverse group of non-Hodgkin lymphomas (NHL). They arise from the malignant transformation of T-lymphocytes, a type of white blood cell integral to the immune system. These malignancies can be classified as either indolent (slow-growing) or aggressive (fast-growing). They can develop in lymphoid tissues like lymph nodes and the spleen, or in extranodal sites such as the gastrointestinal tract, skin, and liver.
Cause	The precise etiology for most T-cell lymphomas is unknown. Several risk factors are associated with an increased incidence. Certain viral infections like Epstein-Barr virus (EBV) and Human T-cell leukemia virus-1 (HTLV-1) are risk factors. Autoimmune conditions such as celiac disease are strongly associated with Enteropathy-Associated T-cell Lymphoma. A weakened immune system, for example, after an organ transplant, increases risk. A family history of lymphoma is also a risk factor.
Pathophysiology	The pathogenesis involves the uncontrolled proliferation of malignant T-cells. This is due to genetic mutations that disrupt normal cell growth, differentiation, and apoptosis. These genetic aberrations can lead to the constitutive activation of key signaling pathways, such as the T-cell receptor (TCR), NOTCH, and JAK/STAT pathways, which promote oncogenesis. The specific anatomic localization of the lymphoma often reflects the normal function of the T-cell counterpart from which it arose. For example, T-cells of the adaptive immune system are primarily nodal, while those of the innate system are often extranodal.
Structural Result	Structurally, T-cell lymphoma manifests as the infiltration and accumulation of malignant lymphocytes in various tissues. This commonly results in lymphadenopathy (swollen lymph nodes), which is often painless. In the abdomen, this can present as confluent mesenteric lymphadenopathy encasing vessels, creating the “sandwich sign” on imaging. Other structural changes include organomegaly (hepatomegaly or splenomegaly), tumor masses in extranodal sites like the intestines, and skin lesions (patches, plaques, or tumors). Intestinal involvement may lead to bowel wall thickening, ulceration, strictures, and, in severe cases, perforation.
Functional Impact	The functional consequences are dictated by the location and extent of organ involvement. Abdominal pain, malabsorption, diarrhea, and weight loss are common with intestinal involvement, such as in Enteropathy-Associated T-cell Lymphoma (EATL). Systemic “B symptoms,” including fever, drenching night sweats, and unexplained weight loss, are frequent, particularly in aggressive subtypes. The proliferation of malignant cells can suppress normal hematopoiesis, leading to cytopenias and an increased risk of infection. Hemophagocytic syndrome, characterized by fever, hepatosplenomegaly, and liver dysfunction, is a serious complication associated with some T-cell lymphomas.
Imaging	18F-FDG PET/CT is the standard and most accurate imaging modality for initial staging, restaging, and assessing treatment response. It combines functional (PET) and anatomic (CT) information, making it superior to CT alone for detecting the full extent of disease, as most T-cell lymphomas are FDG-avid. The CT component of the study reveals key anatomical findings such as lymphadenopathy and organ involvement. In mesenteric lymphoma, it often demonstrates the “sandwich sign,” where enlarged lymph nodes encase mesenteric vessels without significant luminal compression. CT enterography or MR enterography can further delineate intestinal involvement, showing bowel wall thickening, ulceration, and associated mesenteric abnormalities.
Labs	A definitive diagnosis requires a tissue biopsy (excisional or core needle) of an affected lymph node or extranodal site for histopathological examination. Laboratory evaluation includes a complete blood count (CBC) with differential, a comprehensive metabolic panel (CMP), and lactate dehydrogenase (LDH) levels, which are often elevated. Immunophenotyping by flow cytometry or immunohistochemistry is essential to identify the T-cell origin of the lymphoma and its specific subtype based on cell surface markers (e.g., CD30 in Anaplastic Large Cell Lymphoma). Serological tests for viruses like EBV and HTLV-1 may be performed. A bone marrow biopsy may be necessary for staging.
Treatment	Treatment strategies are highly dependent on the specific subtype and stage of the disease. Most aggressive peripheral T-cell lymphomas (PTCLs) are treated with multi-agent chemotherapy regimens, such as CHOP or CHOEP. For CD30-positive lymphomas like anaplastic large cell lymphoma (ALCL), the antibody-drug conjugate brentuximab vedotin may be added. For patients who achieve remission, high-dose chemotherapy followed by autologous stem cell transplant may be considered to reduce the risk of relapse. Novel agents, including histone deacetylase inhibitors (romidepsin) and antifolates (pralatrexate), are options for relapsed or refractory disease.
Prognosis	The prognosis for T-cell lymphoma is highly variable and generally worse than that for B-cell lymphomas. It is heavily influenced by the specific subtype, stage at diagnosis, and the patient’s age. Aggressive subtypes, such as Enteropathy-Associated T-cell Lymphoma, have a very poor prognosis, with five-year survival rates reported to be less than 20%. In contrast, some indolent forms, like early-stage mycosis fungoides, can have a five-year survival rate exceeding 90%. Relapse after initial treatment is common for many aggressive T-cell lymphomas.

4. Medical History and Culture

Section	Description
Etymology	The term lymphoma originates from the Latin lympha, meaning “water,” and the Greek suffix -oma, meaning “morbid growth” or “tumor.” The name was formally used starting in the 1870s. T-cell is a clipping of “thymus cell,” named for the thymus gland where these lymphocytes mature. The “sandwich sign” is a descriptive radiological term for the appearance of mesenteric vessels and fat encased by enlarged lymph nodes.
AKA / Terminology	T-Cell Lymphoma is a form of Non-Hodgkin Lymphoma (NHL). Specific subtypes have their own terminology, such as Lennert lymphoma, also known as lymphoepithelioid lymphoma. The “sandwich sign” is also referred to as the “hamburger sign”.
Historical Notes	The history of lymphoma begins with Thomas Hodgkin, a British physician who, in 1832, first described the features of the lymphatic cancer that now bears his name. For many decades, other types of lymphomas were simply grouped as non-Hodgkin lymphomas. The classification of these diverse cancers evolved significantly over time. The Rappaport classification in 1956 was based on architecture and cell type but made no distinction between B-cells and T-cells. The discovery of T-lymphocytes and their function led to new classification systems. German physician Karl Lennert was pivotal in this area; in 1952 he described what would later be known as Lennert lymphoma, a T-cell variant, and his work contributed to the Kiel classification (1974) which incorporated cellular lineage. Subsequent classifications, like the Revised European-American Lymphoma (REAL) classification in 1994 and the ongoing World Health Organization (WHO) classifications, have further integrated immunophenotypic, genetic, and molecular features to define distinct lymphoma entities.
Cultural or Practice Insights	The approach to lymphoma has undergone a profound transformation, shifting from a mindset of palliation to one of curative intent. This was driven by pioneering clinical research in the 1960s and 70s that established effective radiation and chemotherapy regimens. However, a cancer diagnosis can carry significant cultural stigma and myths, such as beliefs that it is a punishment, contagious, or an automatic death sentence. These cultural views can create fear and shame, causing patients to delay seeking medical help for symptoms, which can negatively impact prognosis. Within medical practice, the recognition of lymphomas as a heterogeneous group of diseases, particularly the distinction between B-cell and T-cell origins, has been crucial. T-cell lymphomas are generally rarer and have a worse prognosis than their B-cell counterparts, necessitating specialized research and treatment approaches.
Notable Figures or Contributions	Thomas Hodgkin (1798–1866): A British pathologist and pioneer in preventive medicine, he first described a malignancy of the lymph nodes in 1832, which was later named Hodgkin’s disease. His work initiated the active involvement of pathologists in the clinical process. Karl Lennert (1921-2012): A German pathologist who was instrumental in developing the Kiel classification of lymphomas. He identified the lymphoepithelioid variant of peripheral T-cell lymphoma, now known as Lennert lymphoma, and advanced the understanding of lymphoma based on cell lineage (T-cell vs. B-cell). Henry S. Kaplan (1918–1984) and Saul A. Rosenberg (1927-2022): This Stanford University team revolutionized lymphoma treatment. Kaplan, a radiation oncologist, developed the first medical linear accelerator in the Western Hemisphere, enabling high-dose, targeted radiation. Together with Rosenberg, an oncologist, they conducted the first randomized clinical trials for lymphoma, combining radiation with chemotherapy and transforming Hodgkin lymphoma from a fatal disease to a highly curable one. Their work became a paradigm for cancer research. Owen A. O’Connor and Thomas Loughran: Contemporary physician-scientists who are leading figures in advancing the understanding and treatment of rare T-cell lymphomas, focusing on developing targeted, chemotherapy-free therapies.
Quotes and/or Teaching Lines	“Knowledge of predisposing factors and radiological signs should help suggest this diagnosis and thus lead to biopsy samples being taken to confirm it.” Regarding the work of Drs. Kaplan and Rosenberg: “The overall product of their efforts… changed the mindset of physicians to approaching these patients with curative intent, rather than traditional palliation which had been the general policy up to the late 1950’s.” On the “sandwich sign”: The radiological significance of the sandwich sign is in suggesting the diagnosis of lymphoma so that appropriate treatment may be initiated early, as the tumour has a rapid growth pattern. It is characteristic, but not specific, for mesenteric lymphoma.

A Poem of the Deceitful Cell

From the marrow’s core, a lineage takes its flight,
To the thymus gland, bathed in nascent light.
A “T” for training, a purpose to defend,
But in one cell, this sacred journey’s end.

A mutiny within, a code that’s gone astray,
The lymphocyte divides, in a relentless ballet.
Through mesenteric fields, the silent armies creep,
While the body’s weary guardians fall to sleep.

On screen, a shadow, a layered, tell-tale sign,
A “sandwich” formed, a stark and somber line.
Vessels encased, a fate that seems concealed,
A truth in tissues, waiting to be revealed.

No Hodgkin’s mark, no Reed-Sternberg’s stare,
A different foe, a burden hard to bear.
Yet history’s pages, by Lennert and by Bright,
Turn palliation’s dusk to cure’s determined light.

6. MCQs

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Part A — Questions

Question	Choices
Q1. The pathogenesis of many T-cell lymphomas involves constitutive activation of key signaling pathways. Which pathway has a preeminent role and is linked to chemotherapy resistance and poor outcomes?	1 ☐ Wnt/β-catenin pathway 2 ☐ Hedgehog signaling pathway 3 ☐ PI3K/AKT/mTOR pathway 4 ☐ JAK/STAT pathway
Q2. Which virally induced oncoprotein potently activates NF-κB and other pathways, driving T-cell proliferation that can culminate in Adult T-Cell Leukemia/Lymphoma (ATL)?	1 ☐ Epstein-Barr nuclear antigen 1 (EBNA1) 2 ☐ Tax 3 ☐ Large T-antigen 4 ☐ E6/E7
Q3. Long-standing, poorly controlled which autoimmune condition confers a high risk for Enteropathy-Associated T-cell Lymphoma (EATL)?	1 ☐ Rheumatoid arthritis 2 ☐ Systemic lupus erythematosus 3 ☐ Celiac disease 4 ☐ Sjögren’s syndrome
Q4. The presence of fever, drenching night sweats, and significant weight loss in a patient with T-cell lymphoma has what primary implication for management and prognosis?	1 ☐ It mandates immediate adjuvant radiation therapy 2 ☐ It modifies the Ann Arbor stage and indicates a worse prognosis 3 ☐ It is classified as a paraneoplastic syndrome requiring high-dose steroids 4 ☐ It is an absolute contraindication for autologous stem cell transplant
Q5. A patient with T-cell lymphoma has completed chemotherapy. A follow-up CECT shows residual mesenteric masses that are now homogeneous and near-fluid density (10–20 HU), and are PET-negative. What does this most likely represent?	1 ☐ Hemorrhagic transformation of the lymphoma 2 ☐ Superimposed fungal infection with abscess formation 3 ☐ Complete metabolic response with sterile, low-density post-treatment changes 4 ☐ Active, viable tumor that has become cystic
Q6. On a staging CT for extensive mesenteric T-cell lymphoma, large confluent nodal masses encase the mesenteric vessels. What associated finding is best explained by the tumor’s impingement on low-pressure lymphatic channels?	1 ☐ Arterial thrombosis and bowel infarction 2 ☐ Chylous (lymphatic) ascites 3 ☐ Mesenteric venous thrombosis 4 ☐ Pneumatosis intestinalis
Q7. The mesenteric “sandwich sign” is highly suggestive of lymphoma but not specific. Which condition can also mimic this appearance?	1 ☐ Sclerosing mesenteritis 2 ☐ Carcinoid tumor 3 ☐ Metastatic carcinoma or infections such as tuberculosis 4 ☐ Retroperitoneal fibrosis

Part B — Answers & Explanations

Question	Answer	Explanation
Q1. The pathogenesis of many T-cell lymphomas involves constitutive activation of key signaling pathways. Which pathway has a preeminent role and is linked to chemotherapy resistance and poor outcomes?	4 — JAK/STAT pathway	JAK/STAT activation is recurrent across PTCL and correlates with proliferation and adverse outcomes. Crescenzo, Cancer Cell 2015
	1 — Wnt/β-catenin	Not a dominant driver across PTCL cohorts.
	2 — Hedgehog	Limited evidence for central pathogenicity in PTCL.
	3 — PI3K/AKT/mTOR	Important in subsets; less uniformly implicated than JAK/STAT.
Q2. Which virally induced oncoprotein potently activates NF-κB and other pathways, driving T-cell proliferation that can culminate in Adult T-Cell Leukemia/Lymphoma (ATL)?	2 — Tax	HTLV‑1 Tax constitutively activates NF‑κB and other cascades, promoting clonal expansion and survival. Matsuoka & Jeang, Nat Rev Cancer 2007
	1 — EBNA1	EBV protein; not the ATL driver.
	3 — Large T‑antigen	Polyomavirus protein; unrelated to HTLV‑1.
	4 — E6/E7	HPV oncoproteins; associated with epithelial cancers.
Q3. Long-standing, poorly controlled which autoimmune condition confers a high risk for Enteropathy-Associated T-cell Lymphoma (EATL)?	3 — Celiac disease	Celiac disease (especially refractory) predisposes to EATL; risk rises with poor dietary adherence. Malamut, Dig Liver Dis 2013
	1 — Rheumatoid arthritis	Raises general lymphoma risk; not specific for EATL.
	2 — Systemic lupus erythematosus	Association not specific to EATL.
	4 — Sjögren’s syndrome	More linked to MALT (B-cell) lymphoma.
Q4. The presence of fever, drenching night sweats, and significant weight loss in a patient with T-cell lymphoma has what primary implication for management and prognosis?	2 — It modifies the Ann Arbor stage and indicates a worse prognosis	These are “B” symptoms, which add the “B” suffix (e.g., IIB) and confer adverse prognosis in risk models. Cheson, J Clin Oncol 2014
	1 — Immediate adjuvant radiation therapy	RT depends on site/stage; B symptoms don’t mandate RT.
	3 — Paraneoplastic syndrome requiring high‑dose steroids	They are staging features, not a separate paraneoplastic entity.
	4 — Absolute contraindication for autologous transplant	High‑risk features may prompt aggressive therapy; not a contraindication.
Q5. A patient with T-cell lymphoma has completed chemotherapy. A follow-up CECT shows residual mesenteric masses that are now homogeneous and near-fluid density (10–20 HU), and are PET-negative. What does this most likely represent?	3 — Complete metabolic response with sterile, low-density post-treatment changes	Residual low‑attenuation “ghost” masses are common after effective therapy; PET‑negativity indicates complete metabolic response (CMR). Barrington, J Clin Oncol 2014
	1 — Hemorrhagic transformation	Acute blood increases attenuation; not near‑fluid density.
	2 — Superimposed fungal infection	Expect rim enhancement/clinical sepsis; not PET‑negative uniform low density.
	4 — Active, viable tumor that became cystic	Viable lymphoma is typically FDG‑avid; cystic change alone ≠ activity.
Q6. On a staging CT for extensive mesenteric T-cell lymphoma, large confluent nodal masses encase the mesenteric vessels. What associated finding is best explained by the tumor’s impingement on low-pressure lymphatic channels?	2 — Chylous (lymphatic) ascites	Lymphatic compression impairs chyle drainage from the gut → chylous ascites; arteries usually remain patent despite encasement. Bhardwaj, J Clin Transl Hepatol 2017
	1 — Arterial thrombosis and bowel infarction	Uncommon; high‑pressure arteries resist occlusion by lymphoma.
	3 — Mesenteric venous thrombosis	Possible with venous compression, but question asks about lymphatic obstruction.
	4 — Pneumatosis intestinalis	Reflects bowel ischemia; not a direct result of lymphatic obstruction.
Q7. The mesenteric “sandwich sign” is highly suggestive of lymphoma but not specific. Which condition can also mimic this appearance?	3 — Metastatic carcinoma or infections such as tuberculosis	Bulky mesenteric adenopathy encasing vessels/fat can result from metastatic gastric, pancreatic, or colorectal carcinoma, and infections like TB. Yang, Clin Radiol 1999
	1 — Sclerosing mesenteritis	Often shows “misty mesentery” ± pseudocapsule, not confluent nodal sandwiching.
	2 — Carcinoid tumor	Typically a desmoplastic spiculated mass with calcification, not homogeneous nodal encasement.
	4 — Retroperitoneal fibrosis	Predominantly retroperitoneal (aorta/IVC/ureters), not small‑bowel mesentery.

Additional Information
see below

7. Memory Page

The Devil’s “Sandwich Sign”

The Devil’s Sandwich

A devil dwells where vessels wind,
Deep in the gut, a hungry find.
With grimy hands and nails so long,
He crafts a deep and growing wrong.

He holds a meal for all to see,
A layered sign of misery.
Two fleshy slabs of tumorous bread,
A growing mass of silent dread.

And in between, a fragile thread,
e silver veins, the arteries red.
The vital filling, neatly placed,
By hungry evil, interlaced.

But note the grip, it is not tight,
It holds the vessels, day and night.
The bread is soft, it yields and bends,
The blood’s own journey never ends.

It’s held, encased, but flows on through,
A telling sign, a vital clue.
So when you see this wicked lunch,
Trust the message, trust your hunch,
It’s lymphoma’s soft and fleshy hand,
That holds the lifeblood of the land.

The Common Vein

VG Med IF b79818-02b01 lymph nodes mesentery massive enlarged sandwich sign T Cell Lymphoma CT lymph nodes mesentery massive enlarged sandwich sign T Cell Lymphoma CT 51F abdominal pain

51-year-old female with abdominal pain

Part A — Questions

2. Findings

Radiological Findings

A) Answers Table

B) Findings Table

Other Images from this Case Axillary Adenopathy And Right Breast Swelling

Renal Involvement

Cardiac Involvement

C) Comments

D) Pearls

3. Diagnosis

4. Medical History and Culture

A Poem of the Deceitful Cell

6. MCQs

Part A — Questions

Part B — Answers & Explanations

7. Memory Page

The Devil’s “Sandwich Sign”

The Devil’s Sandwich

1. Challenge

2. Findings

3. Diagnosis

4. Medical History and Culture

6. MCQs

7. Memory Page

TCV

51-year-old female with abdominal pain

Part A — Questions

2. Findings

Radiological Findings

A) Answers Table

B) Findings Table

Other Images from this Case Axillary Adenopathy And Right Breast Swelling

Renal Involvement

Cardiac Involvement

C) Comments

D) Pearls

Related Links

3. Diagnosis

Related Links

4. Medical History and Culture

A Poem of the Deceitful Cell

Related Links

6. MCQs

Part A — Questions

Part B — Answers & Explanations

Related Links

7. Memory Page

The Devil’s “Sandwich Sign”

The Devil’s Sandwich

Related Links

1. Challenge

2. Findings

3. Diagnosis

4. Medical History and Culture

6. MCQs

7. Memory Page

TCV