Lymphadenopathy

Abstract—Lymphadenopathy is one of the commonest presentation in inflammatory and neoplastic cases. Pathological diagnosis of enlarged lymph nodes is crucial in further management of patients. Fine Needle Aspiration cytology (FNAC) is quick and cost effective OPD procedure for establishing etiology of enlarged lymph nodes. This study was aimed to observed the pattern of lymphadenopathy as per FNAC and its diagnostic accuracy assuming histopathology as gold standard. This study was conducted on two hundred and thirty one consecutive enlarged lymph nodes attended for FNAC in a secondary care level Government Hospital, Gandhi Nagar, Jammu in a study period of two and a half years. Lymph nodes of these cases were aspirated and subjected to cytomorphological evaluation with Papanicolaou (PAP) and Giemsa stain. After that histopathological examination was done of excised biopsies. Then pattern of lymphadenopathy as per FNAC was observed and its diagnostic accuracy was found out assuming histopathology as gold standard. Maximum number of patients was in the age group of 21-30 years age group with male to female ratio 1.2:1. Out of 231 lymphadenopathy cases 4 remain inconclusisve whereas 200 (88.11%)cases were benign and 27 (11.89%) were malignant including 14 (6.1%) cases of metastatic tumors. Among benign cases, majority had non specific reactive lymphadenitis (42.29%) followed by tubercular lymphadenitis. And among malignant tumors, metastatic tumors (6.1%). were most common. Diagnostic accuracy of FNAC was observed as fairly good i.e. ranging from 100% to 83.3% in various type of lymphadenopathies. So it can be depicted that FNAC is very useful first line investigation in patients presenting with enlarged lymph nodes especially in secondary level health care hospitals/centers where advanced diagnostic modalities are not available. The suspicious cases can always be referred for further evaluation.

Abstract
Objective: to report a typical case of Periodic fever associated with aphthous stomatitis, pharyngitis and adenitis (PFAPA); review its characteristics and how to diagnose it in an emergency service.
Case report: female patient, 1 year and 5 months old, presented with recurrent episodes of fever, irritability and lesions of the oral mucosa. The symptoms last for a week and occur monthly since the patient was five months old. Other diseases were excluded and the patient was treated with prednisone during the episodes with improvement of symptoms.
Conclusion: there are several auto-inflammatory diseases described, but the PFAPA is distinguished not only for being the most frequent, but also for being sporadic and for benign nature. The PFAPA is a relatively newly described syndrome that requires dissemination in academic circles leading to a higher index of suspicion among physicians and pediatricians, especially those who take care of patients in the emergency room avoiding unnecessary treatments and evaluation.
Key words: periodic fever, Auto-inflammatory diseases, stomatitis, pharyngitis, lymphadenopathy

Lymphatic filariasis, caused by Wuchereria bancrofti is an important parasitic disease included in the National vector-borne disease control programme in India to bring down the microfilariae carriage rate and disease prevalence in endemic zones in the country. Unplanned urbanization and frequent travel of people from non-endemic areas to endemic areas has increased the threat of this infection, even in non-endemic zones. We report a case of a 19 year old girl from Rajasthan (non-endemic state) who came with the complaint of cervical lymphadenopathy. Extensive follow-up of patient with various investigations such as CBC, urine complete, X-ray, CECT neck, Giemsa staining of PBF, FNAC of lymph node and AFB staining of sputum were carried out when a final diagnosis of lymphatic filariasis could be established by demonstrating live, motile microfilariae in EDTA blood sample collected in night hours. Also, Giemsa-stained PBF revealed sheathed microfilariae with cephalic space: breadth ratio of 1:1, regularly placed purple-coloured nuclei over the entire length and tail-tip free of nuclei.

Accurate lymph node characterization is important in a large number of clinical settings. We evaluated the usefulness of Contrast Enhanced Ultrasound (CEUS) in distinguishing between benign and malignant lymph nodes compared with conventional ultrasonography in the differential diagnosis of superficial lymphadenopathy.We present our experience for 111 patients enrolled in a single center.111 superficial lymph nodes were selected and only 1 lymph node per patient underwent CEUS. A definitive diagnosis for all lymph nodes was obtained by ultrasonographically guided biopsy and/or excision biopsy.The size of the lymph nodes, the site (neck, axilla, inguinal region) being easily accessible for biopsy, and the US and color Doppler US characteristics guided us in selecting the nodes to be evaluated by CEUS.In our study we identified different enhancement patterns in benign and malignant lymph nodes, with a high degree of diagnostic accuracy for superficial lymphadenopathy in comparison wit...

The paper analyses the terminology for the human skin, its functions and diseases in Early Chinese medical manuscripts, and compares findings with early medieval source texts. The often fragmented sources are combed through for descriptions of skin structure, skin sensitivity and its disorders. The topographic body surface description of the mài (vessels), and their relation to inner structures constitutes an impressive theoretical tool that enabled fine-grained analysis of pain, and certain sensory experiences. Examples of skin-related diseases like the lacquer disease and leprosy will be discussed.
• Panel: New Approaches to Chinese Medical Literature (Lo/Harper).
• ICTAM IX Kiel, 6-12 August 2017.
• <http://www.ictam2017.uni-kiel.de/en/vision-statement>

Note:
Evil Kernels Under the Skin • Lymph Node Swellings in Medieval China (Presentation ICTAM IX, Kiel 2017)
Talk clarifiying the culture-specific notion of 'evil kernels' (è hé 惡核) in early medieval China, and their relationship with lymph node swellings, esp. in bubonic plague.
Both a research paper (forthcoming 2018 in Asian Medicine), and a Sourcebook Module will be prepared.

An excerpt is attached.

Abstract. Lymphadenopathy whether benign or malignant represents a diagnostic dilemma in childhood. We tried to evaluate flow cytometric analysis of DNA cycle and apoptotic parameters of fine needle aspiration of lymph node (FNA) or peripheral blood lymphocyte (PBL) samples to resolve
problematic diagnosis of childhood lymphadenopathy. Seventy nine children with lymphadenopathy were enrolled from Outpatient Clinics, Mansoura University Children’s Hospital; 46 FNA and 50 PBL samples were analyzed using FACS flow cytometer. DNA staining was done with propidium
iodide after at least 12 hours ethanol fixation. Apoptosis was measured using the sub-G1 peak analysis. Cases with malignant lymphadenopathy had significantly lower G0/G1 and G2/M peak channels compared to benign cases. Moreover, S-phase and apoptosis percentages were also lower but with statistical insignificant difference. Aneuploidy was significantly higher in PBL samples of malignant cases (P<0.05). Discriminant multivariate analysis showed that FNA samples with low G2/M channel peak (<100), PBL samples with low S-phase (<1.5) and high coefficient of variation (CV) percentages
(>3.5%) were the 3 most significant predictors of malignancy. We can conclude that apoptosis percentage and DNA cycle parameters of FNA and PBL samples in addition to other workup investigations can help in the differentiation of malignant from benign lymphadenopathy.

Key words: flow cytometry • ploidy • apoptosis • lymphadenopathy
* Correspondence: Mohammad S. Al-Haggar, MD, Department of Paediatrics, Faculty of Medicine,
Mansoura University, Mansoura, Egypt, Tel.:+96638982022, +96638982831, Fax:+96638951196, e-mail:
mhajjar2000@yahoo.co.uk

In patients with intrathoracic lymphadenopathy, differentiating tuberculosis from sarcoidosis is often difficult. We hypothesized that Xpert MTB/RIF assay, a semi-automated hemi-nested PCR would help in this regard. To evaluate the performance of Xpert MTB/RIF in the differential diagnosis of tuberculosis and sarcoidosis. This was a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), and were diagnosed as either tuberculosis or sarcoidosis. The results of Xpert MTB/RIF assay, tuberculin skin test and endosonographic characteristics (heterogeneous echotexture and coagulation necrosis sign) of the lymph nodes were compared between the two groups. During the study period, 465 EBUS procedures were performed and a diagnosis of sarcoidosis (n=94) or tuberculosis (n=53) was made in 147 patients. Xpert MTB/RIF was positive in 26 (49.1%) and two (2.1%) patients with tuberculosis an...

Acute lymphoblastic leukemia (ALL), is a lymphoid neoplasm arising from lymphoid progenitors, broadly classified according to lineage into B-cell and T-cell ALL in which T-cell ALL constitutes a small proportion. We are reporting here a case of young female who was diagnosed as T-cell ALL using flow cytometry with acquired trisomy 21, identified on conventional cytogenetics, as a unique finding in this case.

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare benign disorder usually characterized by massive painless cervical lymphadenopathy and systemic manifestations. Extranodal involvement, especially spinal involvement, is extremely rare. We report a 41-year-old man who presented with only intermittent dorsodynia. His condition was diagnosed as non-specific inflammatory disease on the basis of preoperative puncture biopsy results. We performed total surgical resection. Histopathological findings showed distinctive emperipolesis and immunohistochemistry results were positive for cluster of differentiation CD68 and S100 and negative for CD1a. A good prognosis was confirmed at the 3-month follow-up visit. This is the first case of RDD of the subdural spine with such a long segment lesion. There is still no consensus regarding appropriate therapy for this type of RDD and the preoperative diagnosis remains challenging. The unusual presentation of our ...

Background: Due to lack of awareness among health professionals, lymphoma is often misdiagnosed. This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma. Methods: Sixty diagnosed cases of lymphoma were selected (aged 12–65 years) from medical units of Civil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basic laboratory investigations including imaging procedures were done in all the patients. The diagnosis of lymphoma was based on histology, following the International Working Formulation classification system. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The Ann Arbor Staging Classification was used to classify the extent of disease. Results: Out of 60 cases of lymphoma, 81.6 % (49 cases) were diagnosed as non-Hodgkin’s lymphoma and 18.3 % (11 cases) as Hodgkin’s disease, with an overall male predominance. Both categories exhibited a bimodal age distribution. Lymphadenopathy ...

IgG4-related disease (IgG4-RD) is a multi-system fibro-inflammatory disorder with classical histopathological findings, often in the context of elevated serum IgG4 levels. The thoracic manifestations of IgG4-RD are numerous and can mimic several common and better known conditions. The objective of this study was to outline the frequency and nature of thoracic involvement in a prospective cohort of IgG4-RD patients who met defined diagnostic criteria. Over 40% of IgG4-RD patients had clinicoradiological and/or histological evidence of thoracic involvement, predominantly mediastinal lymphadenopathy, the majority associated with multi-system disease outside the chest. Thoracic involvement was associated with a higher serum IgG4 level, potentially representing greater disease activity or spread. Our data highlight the diverse nature of thoracic IgG4-RD, and the importance of knowledge and recognition of the condition among respiratory physicians who are likely to encounter this disease ...

Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care. To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms. A prospective cohort study at a GPs&#39; cooperative (GPC) out-of-hours service. Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (&gt;3 days) after initial contact. Four-hundred and eighty children were analysed, and the overall risk...

BACKGROUND Bartonella infection is the causative organism of cat-scratch disease (CSD), which typically presents with self-limited localized lymphadenopathy. In HIV-infected patients, Bartonella infection can cause systemic illnesses with significant morbidity and mortality manifesting as bacillary angiomatosis (BA), hepatic peliosis, splenitis, bacteremic febrile illness, and other organ involvement. To the best of our knowledge, there have been no reports of HIV-infected patients presenting with generalized lymphadenopathy caused by Bartonella infection. We report an unusual case of CSD presenting with generalized lymphadenopathy in an AIDS patient with advanced immunosuppression. CASE REPORT A 44-year-old woman with AIDS, advanced immunosuppression, and intermittent adherence to antiretroviral therapy and medical care, presented with cough and increased generalized tender lymphadenopathy. A lymph node biopsy 1 year earlier was non-diagnostic for tuberculosis, fungal infection, an...

A 24 year old female presented to us with a history of painless swelling in the neck of 2 weeks duration. After a five day course of antibiotics and anti-inflammatory drugs which proved futile in clearing signs, an excision biopsy was done. This was pathognomonic of kikuchi disease. All drugs were discontinued. The swelling disappeared in four weeks thereafter. There was no other visceral involvement. A six month follow up was uneventful. This case is reported for its rarity.

Carcinoma of the cervix though considered as a preventable disease continues to be a significant health problem worldwide and is the second most frequent cause of cancer death in women in developing countries. Carcinoma of cervix rarely metastasis to supraclavicular group of lymph nodes and very few cases have been reported in the medical literature. Here I report one such case of cancer cervix with unusual manifestation at the time of presentation. A 40yr old lady presented toout patient department of gynaecological oncology, AHRCC, Cuttack, with complaints of irregular menstruation associated with white discharge per vagina, on & off pain abdomen and interestingly swelling in the left supraclavicular region. Cervical biopsy, FNAC of SCLN and ultrasound was done, and a diagnosis of stage IVB was made. She underwent systemicchemotherapy and pelvic irradiation (EBRT and Brachytherapy). She is reported to be disease free after one year of therapy. Though considered to have bad prognosis, stage IVB still can be treated with improved progression free interval and survival rate.