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Van Bockstal MR, Libbrecht L, Dubail A, Berlière M, Galant C. Breast-implant Related Silicone Lymphadenopathy: Asteroid Bodies do not Always Equal Sarcoidosis! Int J Surg Pathol 2023; 31:1099-1104. [PMID: 36314437 DOI: 10.1177/10668969221129890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Silicone breast implants are frequently used for breast augmentation for cosmetic purposes, as well as for breast reconstruction after prophylactic or therapeutic mastectomy. Silicone lymphadenopathy is a well-known complication of silicone breast implants. Silicone droplets are present in the breast tissue through 'silicone bleeding' of the implant or because of implant rupture. These silicone particles can migrate from the breast to the regional lymph nodes. Silicone lymphadenopathy is caused by a substantial foreign body reaction against these silicone particles, and is frequently associated with asteroid body-containing multinucleated giant cells. Similar multinucleated giant cells are often observed in the capsule surrounding the silicone breast implant, and the number of associated asteroid bodies is highly variable. Here, we discuss a series of twelve women with breast implant-related asteroid bodies in their lymph nodes and/or breast tissue. This pictorial essay illustrates that the presence of asteroid bodies in a lymph node does not necessarily suggests a diagnosis of sarcoidosis. Clinical information about the patient having (or having had) silicone breast implants is often lacking. The encounter of asteroid body-containing giant cells in lymph node cytology, biopsies or resections should therefore lead to reflex clinical-pathological correlation, before establishing a final diagnosis.
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Affiliation(s)
- Mieke R Van Bockstal
- Department of Pathology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Louis Libbrecht
- Department of Pathology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Department of Pathology, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Angélique Dubail
- Department of Pathology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Martine Berlière
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Christine Galant
- Department of Pathology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Department of Pathology, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium
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Parsi K, van Rij AM, Meissner MH, Davies AH, Maeseneer MD, Gloviczki P, Benson S, Bottini O, Canata VM, Dinnen P, Gasparis A, Gianesini S, Huber D, Jenkins D, Lal BK, Kabnick L, Lim A, Marston W, Granados AM, Morrison N, Nicolaides A, Paraskevas P, Patel M, Roberts S, Rogan C, Schul MW, Komlos P, Stirling A, Thibault S, Varghese R, Welch HJ, Wittens CHA. Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS) : A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI) This consensus document has been co-published in Phlebology [DOI: 10.1177/0268355520930884] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.05.002]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/). Phlebology 2020; 35:550-555. [PMID: 32639862 PMCID: PMC7441329 DOI: 10.1177/0268355520930884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology
(UIP)
- Australasian College of Phlebology
(ACP)
| | | | - Mark H Meissner
- International Union of Phlebology
(UIP)
- American Venous Forum (AVF)
- American Vein and Lymphatic Society
(AVLS)
| | - Alun H Davies
- Imperial College London, Charing
Cross and St Mary’s Hospital, London, UK
| | | | - Peter Gloviczki
- Division of Vascular and
Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | | | | - Adrian Lim
- Australasian College of Phlebology
(ACP)
| | | | | | - Nick Morrison
- International Union of Phlebology
(UIP)
- American Vein and Lymphatic Society
(AVLS)
| | | | | | | | | | - Christopher Rogan
- Australasian College of Phlebology
(ACP)
- Interventional Radiology Society
of Australasia (IRSA)
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Ayub EM, Bateman DW, Yusuf S. Recurrent Chest Wall and Axillary Lesions in a Teenage Boy. J Emerg Med 2019; 56:715-716. [PMID: 30879845 DOI: 10.1016/j.jemermed.2019.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/08/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Emily M Ayub
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Davis W Bateman
- Baylor College of Medicine, Baylor University, Houston, Texas
| | - Shabana Yusuf
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Kuo PH, Barber BJ, Kylat RI, Klewer SE, Behan S, Lau-Braunhut S, Bernas MJ, Moedano L, Bedrick AD, Mustacich DJ, Witte MH. Whole-body lymphangioscintigraphy and SPECT/CT in children with lymphatic complications after surgery for complex congenital heart disease. Lymphology 2019; 52:157-165. [PMID: 32171182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The number of patients surviving repair of complex congenital heart disease (CCHD) has increased due to improved surgical techniques, post operative management and outpatient care. Likewise, this growing patient population has demonstrated an increasing number and complexity of complications involving the lymphatic system. To evaluate the peripheral and central lymphatic system, whole-body lymphangioscintigraphy (LAS) is considered as the initial imaging evaluation of choice. To date, very few publications exist on the value of lymphatic imaging techniques in infants and small children with lymphatic complications following surgery for congenital heart disease. A retrospective review of medical records from 2008 to 2018 was performed for pediatric patients referred for lymphatic complications after CCHD surgery at an academic medical center. LAS and SPECT/CT was performed using intradermal bipedal injections of Tc 99m labeled filtered sulfur colloid, and in some patients also bilateral hand injections, followed by dynamic imaging and whole- body planar imaging typically up to 180 minutes post injection. Clinical decision making and outcomes were recorded. LAS and SPECT/CT were performed without complication in pediatric patients with prior surgery for CCHD. LAS successfully localized various lymphatic abnormalities such as lymphatic obstruction, reflux, and leaks, which were further delineated by SPECT/CT. LAS findings directed further evaluation with more definitive studies, management and prognosis. Five of the ten patients had follow up outcome data - 2 years and up to 10 years. LAS and SPECT/CT are safe and effective techniques for the initial evaluation of lymphatic abnormalities in pediatric patients with CCHD. LAS, particularly with further 3D localization by SPECT/CT, provides functional imaging of peripheral and central lymphatic flow and thus provides guidance for medical therapy, non operative interventional management, and surgical therapy for these diverse, debilitating, and often life threatening disorders.
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Affiliation(s)
- P H Kuo
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Medicine and Biomedical Engineering (Nuclear Medicine), University of Arizona College of Medicine, Tucson, Arizona, USA
| | - B J Barber
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - R I Kylat
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - S E Klewer
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - S Behan
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - S Lau-Braunhut
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - M J Bernas
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - L Moedano
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - A D Bedrick
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - D J Mustacich
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Gloviczki P, Lawrence PF. JVS-VL is the leading journal in venous and lymphatic disorders. J Vasc Surg Venous Lymphat Disord 2018; 7:1-6. [PMID: 30554741 DOI: 10.1016/j.jvsv.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bruni C, Frech T, Manetti M, Rossi FW, Furst DE, De Paulis A, Rivellese F, Guiducci S, Matucci-Cerinic M, Bellando-Randone S. Vascular Leaking, a Pivotal and Early Pathogenetic Event in Systemic Sclerosis: Should the Door Be Closed? Front Immunol 2018; 9:2045. [PMID: 30245695 PMCID: PMC6137210 DOI: 10.3389/fimmu.2018.02045] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
The early phase of systemic sclerosis (SSc) presents edema as one of the main features: this is clinically evident in the digital swelling (puffy fingers) as well as in the edematous skin infiltration of the early active diffuse subset. Other organs could be affected by this same disease process, such as the lung (with the appearance of ground glass opacities) and the heart (with edematous changes on cardiac magnetic resonance imaging). The genesis of tissue edema is tightly linked to pathological changes in the endothelium: various reports demonstrated the effect of transforming growth factor β, vascular endothelial growth factor and hypoxia-reperfusion damage with reactive oxygen species generation in altering vascular permeability and extravasation, in particular in SSc. This condition has an alteration in the glycocalyx thickness, reducing the protection of the vessel wall and causing non-fibrotic interstitial edema, a marker of vascular leak. Moreover, changes in the junctional adhesion molecule family and other adhesion molecules, such as ICAM and VCAM, are associated with an increased myeloid cells' extravasation in the skin and increased myofibroblasts transformation with further vascular leak and cellular migration. This mini-review examines current knowledge on determinants of vascular leak in SSc, shedding light on the role of vascular protection. This could enhance further studies in the light of drug development for early treatment, suggesting that the control of vascular leakage should be considered in the same way that vasodilation and inflammation reduction, as potential therapeutic targets.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tracy Frech
- Division of Rheumatology, Department of Internal Medicine, Salt Lake Veterans Affair Medical Centre, University of Utah, Salt Lake City, UT, United States
| | - Mirko Manetti
- Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University Federico II, Naples, Italy
| | - Daniel E. Furst
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Rheumatology, University of Washington, Seattle, WA, United States
| | - Amato De Paulis
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University Federico II, Naples, Italy
| | - Felice Rivellese
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University Federico II, Naples, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology and Scleroderma Unit, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology and Scleroderma Unit, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology and Scleroderma Unit, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Liang X, Huang X, Yang Q, He J. Calcified peripancreatic lymph nodes in pancreatic and hepatic tuberculosis mimicking pancreatic malignancy: A case report and review of literature. Medicine (Baltimore) 2018; 97:e12255. [PMID: 30200160 PMCID: PMC6133400 DOI: 10.1097/md.0000000000012255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Tuberculosis remains a serious menace to the health of people. Isolated hepatic tuberculosis is rare and pancreatic tuberculosis is extremely rare. The preoperative diagnosis of pancreatic tuberculosis remains a great challenge. PATIENT CONCERNS A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month. DIAGNOSES Computed tomography (CT) of the abdomen showed a hypodense mass in the pancreatic head and neck with abundant calcifications, a hypodense lesion in the liver without calcification, peripancreatic lymphadenopathy, calcifications in some lymph nodes. CT-guided fine needle aspiration biopsy of the hepatic lesion was carried out and the cytological examination revealed hepatic tuberculosis. INTERVENTIONS The patient was treated with antituberculous therapy for 1 year. OUTCOMES Low back pain and abdominal pain disappeared 3 months after initial treatment and after 2 year of follow-up, the patient was asymptomatic. LESSONS Our data hint that calcifications in both pancreatic lesions and peripancreatic lymph nodes may suggest pancreatic tuberculosis rather than pancreatic malignancy.
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Affiliation(s)
- Xi Liang
- Department of Radiotherapy, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang
| | - Xuequan Huang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Qian Yang
- Department of Gastroenterology, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Jianming He
- Department of Radiotherapy, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang
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Valencia MRP, Takahashi Y, Ishikawa E, Kakizaki H. Compressive optic neuropathy in non-thyroidal lymphocytic infiltrative disorders of the extraocular muscles. Can J Ophthalmol 2018; 54:e81-e84. [PMID: 30975370 DOI: 10.1016/j.jcjo.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Ma Regina Paula Valencia
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.
| | - Eri Ishikawa
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Abstract
The investigation is based on the cytological findings in imprints, stained by the modified Papanicolaou E.A. 50 method, of 190 lymph nodes, of which 10 were normal 60 with benign diseases, 58 with malignant lymphomas and 62 with metastases. The cytological data were controlled by and correlated with histological sections. Touch preparations of lymph nodes do not present technical difficulties, are rapidly prepared and are always satisfactory. Cytological details are much better preserved and more recognizable than in histological sections but little information on lymph node organization is yielded. Imprints do not replace tissue diagnoses or even frozen sections, but under certain circumstances they may supply sufficient data for immediate diagnostic purposes, such as findings of metastatic malignant tumor cells or of Reed-Sternberg cells and their variants in lymph nodes during laparatomy for the staging of Hodgkin's disease. In addition to their supplementary diagnostic as well as teaching value, touch preparations allow minute caryological observations in malignant lymphomas. Peculiar basic nuclear structures in both well and poorly differentiated lymphocytic lymphomas and two different nuclear types in histiocytic lymphoma are described. The variations and frequency of several cell types (reticulum cells, lymphocytes, histiocytes, Reed-Sternberg and lacunar cells) in Hodgkin's disease are described and correlated with the histologic type.
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Abstract
Dorfman and Warnke (3) have previously described varieties of lymphadenopathy simulating malignant lymphomas, and they have emphasized the diagnostic difficulties encountered. At the Gustave-Roussy Institute, we have observed 2 cases of lymphadenopathy, in young boys, which mimicked lymphoma. No reference to the particular clinical and histological features of this disorder could be found in the literature. The boys, 2 and 3 years of age, presented with massive cervical adenopathy, hepatosplenomegaly and intermittent fever, associated with a chronic nasopharyngitis, anemia and eosinophilia. Specific adenitis could be eliminated on the basis of laboratory data. No definite diagnosis could be established upon microscopic evaluation of the nodes. None of the pathologists, asked in consultation, was able to determine whether the lesion was malignant or not. Under these circumstances, 1 of the patients was treated by methotrexate and steroids, and the other by radiotherapy, neither with complete success. Fever and adenopathy continued off and on over a period of 5 years. However, at 7 years follow-up, both patients are now without evidence of disease. Microscopically, the features of the lymph nodes of these 2 patients were quite similar. Lymphoid tissue was more or less replaced by a diffuse histiocytosis with necrotic areas. Giant cells and macrophages could be found in the vicinity of the necrotic areas. Plasma cells, eosinophils, mast cells and bizarre cells simulating Reed-Sternberg cells were also observed. It was necessary to rule out 4 major diagnoses: Letterer-Siwe disease, sinus histiocytosis of Rosai and Dorfman, malignant histiocytosis, and Hodgkin's disease of the epithelioid type. The possibility of a new entity, which appears to have a self-limited course, must be recognized, if inappropriate use of radical therapy is to be avoided. The etiology of this pseudo-malignant necrotic histiocytosis is not clear and, for the moment, no precise pathogenesis can be proposed.
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Abstract
The clinical records and histologic material of 18 consecutive patients with malignant histiocytosis were reviewed. The age of the patients ranged from 20 months to 72 years (median 35 years). There were 14 males and 4 females (3.5:1). Lymph node and liver enlargement, fever, and skin nodules were the most common physical findings; and leukocytosis was frequently the most abnormal laboratory test. Seven of 18 patients died, and their survival ranged from 1 to 15 months (median 8 months) after histopathologic diagnosis. The histologic findings on lymph nodes, spleen, liver, bone marrow, and skin were investigated with special reference to both the cellular composition and the pattern of lymph node involvement. Vascular invasion of small perinodal vessels was observed in 4 fatal cases. The absence of capsular invasion and the lack of cohesiveness among atypical proliferating histiocytes of malignant histiocytosis appeared to be inconstant. Sequential lymph node biopsies revealed in later stages the extension of the histiocytic proliferation from the sinuses into the cords and the complete obliteration of the nodal structures. The radiologic investigations yielded numerous pathologic findings that were consistent with the dissemination of the disease. Complete response to initial treatment was achieved in patients that were treated with radiotherapy and/or chemotherapy. Complete response with chemotherapy was achieved only when the treatment included adriamycin. The histologic and clinical features of the present series provide further evidence for the recognition of malignant histiocytosis as a distinct clinical and pathologic entity.
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Karamise ŞE, Gunay S, Gunay E. Bronchonodal Fistula in an Immunocompetent Adult. Arch Bronconeumol 2018; 54:526. [PMID: 29550082 DOI: 10.1016/j.arbres.2018.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Şule Esen Karamise
- Department of Chest Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Sibel Gunay
- Clinic of Chest Diseases, Afyon State Hospital, Afyonkarahisar, Turkey
| | - Ersin Gunay
- Department of Chest Diseases, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey.
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Masunaga A, Ishibashi F, Koh E, Oide T, Sekine Y, Hiroshima K. Possible relationship between fibrosis of IgG4-related thymitis and the profibrotic cytokines, transforming growth factor beta 1, interleukin 1 beta and interferon gamma: a case report. Diagn Pathol 2018; 13:6. [PMID: 29439708 PMCID: PMC5811959 DOI: 10.1186/s13000-018-0684-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND IgG4-related disease often forms a mass and the affected lesion is clinically removed because the mass cannot be differentiated from a neoplasm. Affected lesions commonly occur in the pancreas, hepatobiliary tract, kidney, and retroperitoneum. However, the lesion rarely occurs in the thymus. A histological worldwide consensus of IgG4-related disease proposed that pathological diagnosis of IgG4-related disease should meet more than two of three major features: 1) dense lymphoplasmacytic infiltration with greater than 40% IgG4+/IgG+ plasma cells, 2) storiform fibrosis; and 3) obliterative phlebitis. Currently, fibrosis of IgG4-related disease is thought to be induced by profibrotic cytokines such as transforming growth factor beta 1 (TGFB1), interleukin 1 beta (IL1B) and interferon gamma (IFNG), which are secreted by regulatory T cells (Tregs) and CD4-positive cytotoxic T cells. However, it is unclear whether profibrotic cytokines are associated with the fibrosis seen in IgG4-related thymitis. Here we examined whether cytokines in the mass were increased compared with those in the surrounding thymus, and whether Tregs were present in the mass, using reverse transcription absolute quantitative polymerase chain reaction (RT-ab-qPCR) and immunohistochemistry. CASE PRESENTATION A 70-year-old Japanese man contracted IgG4-letated thymitis. Histological and immunohistochemical analyses demonstrated his mass had massive fibrosis with a focally storiform pattern and lymphoplasmacytic infiltration with 40% IgG4+/IgG+ plasma cells, but not obliterative phlebitis. The mass was surrounded by atrophic thymus. We diagnosed the mass as IgG4-related thymitis. Immunohistochemically, Tregs were scattered throughout the mass. RT-ab-qPCR showed that messenger RNA expressions of TGFB1, IL1B and IFNG in the mass were 270-, 158- and 5.5- fold higher than in the surrounding thymus. His serum IgG4 level after surgery was within the normal range (83.4 mg/dl soon after surgery, 89.3 mg/dl 2 weeks after surgery). CONCLUSIONS Our results suggested the profibrotic cytokines TGFB1, IL1B and IFNG induce fibrosis and that Tregs might produce some of these cytokines in IgG4-related thymitis as well as in the other affected lesions of IgG4-related disease.
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Affiliation(s)
- Atsuko Masunaga
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa Japan
| | - Fumihiro Ishibashi
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Eitetsu Koh
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Takashi Oide
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
| | - Yasuo Sekine
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
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Ma J, Wang YC, Sun XW, Sun CY. [Atypical computed tomography manifestations of thoracic sarcoidosis]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:925-930. [PMID: 29224303 DOI: 10.3760/cma.j.issn.1001-0939.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: This study evaluated the atypical computed tomography (CT) manifestations of thoracic sarcoidosis. Methods: Medical data of 190 patients with thoracic sarcoidosis were retrospectively reviewed. Results: The atypical CT manifestations of thoracic sarcoidosis observed were unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy(n=12, 6.3%), mediastinal lymphadenopathy without hilar lymphadenopathy(n=9, 4.7%), patchy consolidation (n=23, 12.1%), sarcoid galaxy sign (n=22, 11.6%), reversed halo sign (n=1, 0.5%), and ground-glass opacities (n=52, 27.4%). Air trapping was found in 8 of 10 patients who underwent both inspiratory and expiratory CT. Post-treatment CT scans showed improvements in most patients. Of the 12 patients with unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy, 10(83.3%) improved. Of the 9 patients with mediastinal lymphadenopathy without hilar lymphadenopathy, 8(88.9%) improved. Of the 23 patients with patchy consolidation, 15(65.2%) improved. Of the 22 patients with the sarcoid galaxy sign, 16(72.7%) improved. The patient with the reversed halo sign improved completely. Of the 52 patients with ground-glass opacities, 31(59.6%) improved. Of the 8 patients with air trapping, 7(87.5%) improved. Conclusions: The atypical imaging manifestations of thoracic sarcoidosis included unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy, mediastinal lymphadenopathy without hilar lymphadenopathy, patchy consolidation, the sarcoid galaxy sign, the reversed halo sign, ground-glass opacity, and air trapping. These lesions mostly improved after treatment. Familiarity with these atypical signs will help increase the diagnostic accuracy of imaging studies for thoracic sarcoidosis.
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Affiliation(s)
- J Ma
- Department of Radiology, Shanghai Pulmonary Hospitial, Tongji University School of Medicine, Shanghai 200433, China
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Ruiz-Clavijo García D, García de Galdiano Fernández A, González de la Higuera Carnicer B, Rubio-Marco I, Mercado Gutiérrez M. Cavitating mesenteric lymph node syndrome: An uncommon complication of celiac disease. Rev Gastroenterol Mex 2017; 82:351-353. [PMID: 28237524 DOI: 10.1016/j.rgmx.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/21/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Affiliation(s)
- D Ruiz-Clavijo García
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | | | | | - I Rubio-Marco
- Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Mercado Gutiérrez
- Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Abstract
Adult onset Still’s disease (AOSD) is a chronic inflammatory disorder involving multiple systems. The symptoms mimic those of lymphomas, therefore, the diagnosis of lymphoma needs to be excluded prior to establishing the diagnosis of AOSD. Another similar condition is dermatopathic lymphadenopathy (DL). In DL, the histopathological appearance of lymph node biopsy may also mimic AOSD. The DL is associated with several systemic pathologies, such as malignant lymphomas, and rarely AOSD. We present a case of a 43-year-old male presented with 3 months history of fatigue, fever, and lymphadenopathy. Initial work-up satisfactorily met the criteria for diagnosis of AOSD. But considering the well-known association of DL with hematological malignancies, detailed pathological studies were considered, including tumor markers to rule out the possibility of malignancy. The patient was started on steroids and showed remarkable recovery within 2 weeks. Evaluation of malignant lymphomas in a patient with DL is important, in order to diagnose AOSD and rule out hematological malignancy.
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Affiliation(s)
- Ahmad Z Qureshi
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Menon S, Chennapragada M, Ugaki S, Sholler GF, Ayer J, Winlaw DS. The Lymphatic Circulation in Adaptations to the Fontan Circulation. Pediatr Cardiol 2017; 38:886-892. [PMID: 28210768 DOI: 10.1007/s00246-017-1576-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/20/2017] [Indexed: 11/25/2022]
Abstract
Failing Fontan continues to be major problem for patients on the univentricular pathway. Failing Fontan is often complicated by chylothorax, plastic bronchitis and protein loosing enteropathy. The role of lymphatic circulation in Fontan circulation is still being researched. Newer imaging modalities give insight into the role of abnormal dilatation and retrograde flow in lymphatic channels post Fontan. Interventional strategies targeting abnormal lymphatic channels, provides an alternative management strategy for patients with failing Fontan. This review focuses on the role of lymphatic system in adaptations to Fontan circulation.
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Affiliation(s)
- Sabarinath Menon
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Sree Chitra Tirunal Institute of Medical sciences and Technology, Thiruvananthapuram, Kerala, 695,011, India
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Murthy Chennapragada
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Shinya Ugaki
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Gary F Sholler
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Julian Ayer
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - David S Winlaw
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
- Sydney Children's Hospital Network, The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
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Cho W, Kim MK, Sim JS. Ultrasound-guided core needle biopsy of cervical lymph nodes in the diagnosis of toxoplasmosis. J Clin Ultrasound 2017; 45:192-196. [PMID: 27874221 DOI: 10.1002/jcu.22431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/23/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Our study investigates whether the histopathological features of toxoplasmic lymphadenitis (TL), specifically noncaseating microgranuloma and follicular hyperplasia, can be obtained by sonographic-guided core needle biopsy (CNB) of cervical lymph nodes. METHODS Thirty-two patients seen from June 2014 to March 2015 were positive for toxoplasma immunoglobulin M antibody. Among those patients, 21 underwent CNB of a cervical lymph node and were enrolled in this study. The pathologic findings were reviewed. RESULTS Twenty-nine lymph nodes in 21 patients were sampled. Eighteen of the 21 (86%) patients had a microgranuloma without caseating necrosis or giant cells, and all 21 (100%) patients had follicular hyperplasia. CONCLUSIONS The histologic findings of TL were detected by sonographic-guided CNB, which can be used as part of the first line of investigation in patients with unexplained cervical adenopathy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:192-196, 2017.
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Affiliation(s)
- Woojin Cho
- Department of Otolaryngology-Head and Neck Surgery, Withsim Clinic, Gyeonggi-do, Korea
| | | | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Gyeonggi-do, Korea
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Kandelaki G, Malania L, Bai Y, Chakvetadze N, Katsitadze G, Imnadze P, Nelson C, Harrus S, Kosoy M. Human Lymphadenopathy Caused by Ratborne Bartonella, Tbilisi, Georgia. Emerg Infect Dis 2016; 22:544-6. [PMID: 26889959 PMCID: PMC4766887 DOI: 10.3201/eid2203.151823] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lymphadenopathy and fever that developed in a woman in Tbilisi, Georgia, most likely were caused by a ratborne Bartonella strain related B. tribocorum and B. elizabethae. The finding suggests that this Bartonella strain could be spread by infected rats and represents a potential human risk.
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Silowash R, Pantanowitz L, Craig FE, Simons JP, Monaco SE. Utilization of Flow Cytometry in Pediatric Fine-Needle Aspiration Biopsy Specimens. Acta Cytol 2016; 60:344-353. [PMID: 27592067 DOI: 10.1159/000448510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/18/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) coupled with flow cytometry (FC) can be helpful in suspicious pediatric lymph nodes or masses to exclude a lymphoproliferative disorder. The aim of this study was to analyze FC findings in a series of pediatric FNAs and to correlate abnormal findings with follow-up information. MATERIALS AND METHODS All pediatric FNAs performed at a tertiary-care children's hospital over a 46-month period that had FC performed were retrospectively analyzed and correlated with follow-up. RESULTS A total of 163 FNA procedures were performed in children (age ≤21 years), and 47 (28.8%) of these cases had FC performed. Specimens were mostly obtained from the head and neck (72.3% of cases). Nine cases (19.1%) had abnormal FC findings, including double-negative T cells (n = 3; 33.3%), double-positive T cells (n = 3; 33.3%), excess λ light chains (n = 1; 11.1%), weak CD34 positivity (n = 1; 11.1%), and T-lymphoblastic lymphoma (n = 1; 11.1%). CONCLUSION Unusual FC results that are not diagnostic of malignancy can be seen in lymph node FNA in a minority of young patients. In our series, these findings were seen mainly in small populations of T cells and occurred primarily in the setting of reactive lymphoid hyperplasia or ectopic thymic tissue. Cytopathologists performing FNA on children should be aware of these abnormalities and, although they may warrant further investigation and follow-up, they are unlikely to be associated with malignancy.
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Affiliation(s)
- Russell Silowash
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA
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22
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Moore SA, Abbara S, Mak GS, Mark EJ, Stone JR. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 22-2016. A 65-Year-Old Man with Syncope, Dyspnea, and Leg Edema. N Engl J Med 2016; 375:262-72. [PMID: 27468063 DOI: 10.1056/nejmcpc1601838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stephanie A Moore
- From the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Harvard Medical School - both in Boston
| | - Suhny Abbara
- From the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Harvard Medical School - both in Boston
| | - Gary S Mak
- From the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Harvard Medical School - both in Boston
| | - Eugene J Mark
- From the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Harvard Medical School - both in Boston
| | - James R Stone
- From the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (S.A.M., G.S.M.), Radiology (S.A.), and Pathology (E.J.M., J.R.S.), Harvard Medical School - both in Boston
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Georgalas C, Thomas K, Owens C, Abramovich S, Lack G. Medical Treatment for Rhinosinusitis Associated with Adenoidal Hypertrophy in Children: An Evaluation of Clinical Response and Changes on Magnetic Resonance Imaging. Ann Otol Rhinol Laryngol 2016; 114:638-44. [PMID: 16190098 DOI: 10.1177/000348940511400810] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. Methods: Thirteen children referred to a tertiary allergy clinic with symptoms of rhinosinusitis received medical treatment over a 4-month period. All underwent MRI before and after treatment. The medical treatment regimen comprised a short course of oral antibiotics and oral steroids and a longer course of oral antihistamines and intranasal steroids. Results: The pretreatment MRI demonstrated enlarged adenoids and rhinosinusitis in all 13 children, with evidence of extensive rhinosinusitis in 9 of the 13. The treatment resulted in an improvement in overall symptom score; the most significant improvement was seen in mouth breathing. The posttreatment MRI showed a statistically significant reduction in adenoid size and adenoid/nasopharynx ratio, which was associated with a significant decrease in sinus involvement on MRI. Conclusions: There is a high association between adenoidal hypertrophy and rhinosinusitis in the context of an allergy clinic. Magnetic resonance imaging can document the changes in adenoid size associated with resolution of rhinosinusitis. Further studies are necessary to validate these pilot data and further assess the effects of medical treatment and the role of MRI in adenoidal hypertrophy.
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Abstract
IMPORTANCE Early, accurate diagnosis of infectious mononucleosis can help clinicians target treatment, avoid antibiotics, and provide an accurate prognosis. OBJECTIVE To systematically review the literature regarding the value of the clinical examination and white blood cell count for the diagnosis of mononucleosis. DATA SOURCES The databases of PubMed (from 1966-2016) and EMBASE (from 1947-2015) were searched and a total of 670 articles and abstracts were reviewed for eligibility. STUDY SELECTION Eleven studies were included that reported data sufficient to calculate sensitivity, specificity, or both for clinical examination findings and white blood cell count parameters compared with a valid reference standard. DATA EXTRACTION AND SYNTHESIS Data were abstracted from each article by at least 2 reviewers, with discrepancies reconciled by consensus. Clinical findings evaluated in only 1 study are reported with sensitivity, specificity, likelihood ratio (LR), and 95% confidence interval, which were calculated from the available data. Findings evaluated in only 2 studies were summarized with their range, findings evaluated in 3 studies were summarized with a univariate random-effects summary, and findings evaluated in 4 or more studies were summarized with a bivariate random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and LRs for the diagnosis of mononucleosis. RESULTS Mononucleosis is most commonly present among patients aged 5 to 25 years (especially those aged 16-20 years, among whom approximately 1 in 13 patients presenting with sore throat has mononucleosis). The likelihood of mononucleosis is reduced with the absence of any lymphadenopathy (summary sensitivity, 0.91; positive LR range, 0.23-0.44), whereas the likelihood increases with the presence of posterior cervical adenopathy (summary specificity, 0.87; positive LR, 3.1 [95% CI, 1.6-5.9]), inguinal or axillary adenopathy (specificity range, 0.82-0.91; positive LR range, 3.0-3.1), palatine petechiae (specificity, 0.95; positive LR, 5.3 [95% CI, 2.1-13]), and splenomegaly (specificity range, 0.71-0.99; positive LR range, 1.9-6.6). Symptoms are of limited value for the diagnosis of mononucleosis; sore throat and fatigue are sensitive (range, 0.81-0.83) but nonspecific. The presence of atypical lymphocytosis significantly increases the likelihood of mononucleosis (summary LR, 11.4 [95% CI, 2.7-35] for atypical lymphocytes ≥10%, 26 [95% CI, 9.6-68] for those with 20%, and 50 [95% CI, 38-64] for those with 40%). The combination of a patient having greater than 50% lymphocytes and greater than 10% atypical lymphocytes also is useful (specificity, 0.99; positive LR, 54 [95% CI, 8.4-189]). CONCLUSIONS AND RELEVANCE In adolescent and adult patients presenting with sore throat, the presence of posterior cervical, inguinal or axillary adenopathy, palatine petechiae, splenomegaly, or atypical lymphocytosis is associated with an increased likelihood of mononucleosis.
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Affiliation(s)
- Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Atlanta
| | - Marlene Call
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Atlanta2Now a PhD candidate at Georgia Health Sciences University, Augusta
| | - JoAnna Shinholser
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Atlanta
| | - Jack Gardner
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Atlanta
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Ikeura T, Takaoka M, Uchida K, Shimatani M, Miyoshi H, Kato K, Ohe C, Uemura Y, Kaibori M, Kwon AH, Okazaki K. Fluorescence cytology with 5-aminolevulinic acid in EUS-guided FNA as a method for differentiating between malignant and benign lesions (with video). Gastrointest Endosc 2016; 81:1457-62. [PMID: 25865388 DOI: 10.1016/j.gie.2015.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) has been increasingly performed to obtain specimens for the pathological evaluation of patients with GI and pancreaticobiliary masses as well as lymphadenopathies of unknown origin. Photodynamic diagnosis by using 5-aminolebulinic acid (ALA) has been reported to be useful for enabling the visual differentiation between malignant and normal tissue in various cancers. OBJECTIVE To evaluate the diagnostic accuracy of fluorescence cytology with ALA in EUS-FNA. DESIGN A prospective study. SETTING A single center. PATIENTS A total of 28 consecutive patients who underwent EUS-FNA for the pathological diagnosis of a pancreaticobiliary mass lesion or intra-abdominal lymphadenopathy of unknown origin. INTERVENTIONS Patients were orally administered ALA 3 to 6 hours before EUS-FNA. The sample was obtained via EUS-FNA for fluorescence cytology and conventional cytology. A single gastroenterologist performed the fluorescence cytology by using fluorescence microscopy after the procedure, independently of the conventional cytology by pathologists. MAIN OUTCOME MEASUREMENTS The accuracy of fluorescence cytology with ALA in the differentiation between benign and malignant lesions by comparing the results of fluorescence cytology with the final diagnosis. RESULTS Of the 28 patients included in the study, 22 were considered as having malignant lesions and 6 patients as having benign lesions. Fluorescence cytology could correctly discriminate between benign and malignant lesions in all patients. Therefore, both the sensitivity and specificity of fluorescence cytology were 100% in our study. LIMITATIONS Fluorescence cytology was performed by only 1 gastroenterologist with a small number of patients. CONCLUSION Fluorescence cytology with ALA in EUS-FNA may be an effective and simple method for differentiating between benign and malignant lesions.
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Affiliation(s)
- Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Makoto Takaoka
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazushige Uchida
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masaaki Shimatani
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Hideaki Miyoshi
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kota Kato
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Chisato Ohe
- Department of Pathology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
| | - Yoshiko Uemura
- Department of Pathology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - A-Hon Kwon
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Kazuichi Okazaki
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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Miura I. [Programs for Continuing Medical Education: B session; 7. Differential diagnosis of lymph node swelling and the choice of the treatments for lymphoma]. Nihon Naika Gakkai Zasshi 2016; 105:505-510. [PMID: 27319201 DOI: 10.2169/naika.105.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Zagaba LM, Opanasenko MS, Borysova VI, Yatsyna MF, Tereshkovych OV, Kshanovskiy OE, Kupchak IM, Konik BM, Kalenychenko MI, Obremska OK, Bychkovskiy VB. [DIAGNOSTIC SIGNIFICANCE OF CYTOLOGICAL AND HISTOLOGICAL INVESTIGATION OF THE BIOPSY MATERIAL FOR DETERMINATION OF ETIOLOGY OF THE INTRATHORACIC LYMPHADENOPATHY SYNDROME]. Klin Khir 2016:56-59. [PMID: 27244922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Department of Thoracic Surgery and Invasive Methods of Diagnosis in 2008-2014 yrs 132 biopsy specimen of intrathoracic lymph nodes with further cytological and histological investigation, taken in patients, who were treated for the intrathoracic lymphadenopathy syndrome of unknown etiology, were analyzed. Sensitivity, specificity and general accuracy of cytological and histological diagnosis were determined, while applying various methods of the biopsy material selection.
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Zivković NP, Ostović KT, Bosnjak D, Tudorić N. [INITIAL RESULTS OF DIAGNOSTIC APPLICATION OF ENDOBRONCHIAL ULTRASOUND IN CLINICAL HOSPITAL DUBRAVA]. Lijec Vjesn 2016; 138:34-38. [PMID: 27290812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Endobronchial ultrasound (EBUS) enables visualization of mediastinal and hilar lymph nodes as well as, in case of clinical indication, its transbronchial needle aspiration (TBNA). Simultaneous application of color doppler gives the additional prospects to investigate the blood vessels. The primary indication for EBUS is radiographic finding of mediastinal and/or hilar lymph nodes enlargement as well as the staging of non-small cell lung cancer (NSCLC). In this article we present the initial results of application of this valuable diagnostic procedure performed at the Department for pulmonary diseases in Clinical hospital Dubrava in Zagreb. According to its high sensitivity and specificity, and being safe and well tolerated, EBUS-TBNA was positioned as basic diagnostic procedure in patients with mediastinal lymphadenopathy.
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Osinka K, Zielińska-Krawczyk M, Korczyński P, Górnicka B, Krenke R. Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement. Adv Exp Med Biol 2016; 911:33-43. [PMID: 26987324 DOI: 10.1007/5584_2016_222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience.
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Affiliation(s)
- K Osinka
- Medical Student Research Group 'Alveolous', Medical University of Warsaw, Warsaw, Poland
| | - M Zielińska-Krawczyk
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
| | - P Korczyński
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland.
| | - B Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - R Krenke
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
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Simper N, Deveaux PG, Burgess PL. An Unusual Case of Lymphadenopathy Due to Traumatic Foreign-Body-Associated Granulomatous Lymphadenitis. Am Surg 2015; 81:E422-E423. [PMID: 26736150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Novae Simper
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Nagashima D, Shibutani M, Maeda K, Nagahara H, Ohtani H, Sakurai K, Yamazoe S, Kimura K, Toyokawa T, Amano R, Kubo N, Tanaka H, Muguruma K, Ohira M, Hirakawa K. [A Case of Demonstrating the Difficulties in Deciding How to Manage the Clinical Results after Rectal Resection]. Gan To Kagaku Ryoho 2015; 42:2259-2261. [PMID: 26805330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is important in the clinical setting to integrate all of the findings when diagnosing and making treatment decisions. We report a case of particular interest for managing cancer patients. A 69-year-old man underwent endoscopic resection for an Rb rectal tumor. The tumor showed a positive vertical margin and required laparoscopy-assisted super low anterior resection with ileostomy for histopathological stage Ⅰrectal cancer. His postoperative course was uneventful. The follow-up computed tomography (CT) scan revealed a tumor locating close to the left common iliac artery. Although positron emission tomography (PET) showed 18F-fluorodeoxyglucose (FDG) accumulation in the tumor, none of the other clinical findings indicated a recurrence of rectal cancer. FDG is not specific to malignant neoplasias, but the location of the tumor and the FDG uptake suggested the possibility of malignancy. No other tests found any evidence of a recurrence. Tumor resection was performed concurrently with ileostomy closure. Histopathology demonstrated it was an asymptomatic abscess in a lymph node. Tumor recurrence and metastases have to be kept in mind even if the primary lesion is in an early stage. This case shows the difficulty in deciding how to manage patients when clinical results are not consistent, especially in cases needing surgical procedures.
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Affiliation(s)
- Daisuke Nagashima
- Dept. of Surgical Oncology, Osaka City University Graduate School of Medicine
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Mathur P, Shah S, Beck M. Fever. Eschars on right leg and groin. Inguinal lymphadenopathy. Dx? J Fam Pract 2015; 64:720-723. [PMID: 26697535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Poonam Mathur
- University of Maryland Medical Center, Baltimore, MD, USA.
| | - Shenil Shah
- Department of Internal Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael Beck
- Department of Internal Medicine and Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Harris RM, Arnaout R, Koziel H, Folch E, Majid A, Kirby JE. Utility of microbiological testing of thoracic lymph nodes sampled by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal lymphadenopathy. Diagn Microbiol Infect Dis 2015; 84:170-4. [PMID: 26602949 DOI: 10.1016/j.diagmicrobio.2015.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a minimally invasive technique to sample peribronchial and mediastinal lymph nodes for diagnosis of cancer, lymphoma, or sarcoidosis. However, the value of EBUS-TBNA in diagnosis of respiratory infections has not been well explored. Here, microbiologic testing data for EBUS-TBNA samples collected from 82 patients over a 30-month period were retrospectively reviewed. No organisms were identified on Gram, acid-fast, or fungal stains. Bacterial cultures were positive in 52% of samples; however, all but 1 culture were considered contaminants. Mycobacterial cultures yielded Mycobacterium avium-intracellulare not identified in a concurrent bronchoalveolar lavage sample in 1 patient. Fungal cultures were negative. Overall, routine microbiologic tests on EBUS-TBNA samples do not appear sufficiently sensitive to rule out infectious causes of adenopathy. High clinical suspicion for infection may require modification of sampling techniques or more sensitive detection methods.
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Affiliation(s)
- Rebecca M Harris
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Ramy Arnaout
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Henry Koziel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Erik Folch
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Adnan Majid
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - James E Kirby
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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Kim MI. A PHYSICAL EXAMINATION MANEUVER THAT FACILITATES PALPATION OF CERVICAL LYMPHADENOPATHY. Endocr Pract 2015; 21:1185-6. [PMID: 26439004 DOI: 10.4158/1934-2403-21.10.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bilgin Büyükkarabacak Y, Taslak Şengül A, Meydan BC, Çelik B, Pirzirenli MG, Gürz S, Sürücü ZP, Başoğlu A. The risk of tumor cell dissemination in mediastinoscopy: a cytological study. Turk J Med Sci 2015; 45:872-6. [PMID: 26422860 DOI: 10.3906/sag-1406-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. MATERIALS AND METHODS The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. RESULTS The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre- and postbiopsy lavage samples were reported to be positive for malignancy. CONCLUSION While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.
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Opanasenko MS, Konik BM, Kupchak IM, Kshanovskyi OE, Tereshkovych OV, Stasiv TM, Klymets EV. [APPLICATION OF VIOEOTHORACOSCOPIC PROCEDURES IN A SYNDROME OF INTRATHORACIC LYMPHADENOPATHY OF UNDETERIVIINED ORIGIN]. Klin Khir 2015:41-43. [PMID: 26946659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Enhancement of rate of the intrathoracic lymphadenopathy syndrome (ILS) revealing have caused a necessity to find out the informative, secure and miniinvasive method of its diagnosis. There was established, that sensitivity, specificity and accuracy of videothoracoscopic (VTS) biopsy of intrathoracic lymph nodes (ILN) have constituted, accordingly, 96.0, 98.1 and 97.1%, and of videoassisted thoracoscopy (VATS) - 93.8, 93.6 and 93.5%. Low frequency of intraoperative and postoperative complications (accordingly 4.4 and 7.7%), small intraoperative blood loss (29 ml), short duration of operative intervention (45 min), rapid rehabilitation of patients postoperatively (10.6 days) witnesses about expediency of application of a VTS biopsy and VATS as a safe and miniinvasive procedures in ILS.
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Kuchuk M, Guber A, Koslow M, Matveitchouk A, Shitrit D. [ENDOSCOPIC ULTRASOUND EXAMINATION IN ELDERLY LUNG PATIENTS: OUR EXPERIENCE AT MEIR MEDICAL CENTER]. Harefuah 2015; 154:481-542. [PMID: 26480609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The endobronchial ultrasound (EBUS) examination is the prime choice in patients with unexplained mediastinal lymphadenopathy. We summarize our experience at Meir Medical Center with EBUS in the elderly (over 75 years of age) patients with lung cancer including indications, benefits and risks factors. METHODS The study included 20 patients over the age of 75, 13 men and 7 women. The average age was 81 ± 5 years. Indications included 11 patients with lung cancer and nine patients with mediastinal lymphadenopathy. Sixteen patients (80%] were diagnosed by the EBUS. Three patients needed a further diagnostic procedure. There was test accuracy in 18 of 20 patients (90%). Side effects included: One patient developed severe cough and another patient developed hypoxemia without the need for respiration, no bleeding was observed and there were no decreases in blood pressure. There was no arrhythmia or other complications. All patients were released on the examination day. CONCLUSIONS The efficacy and safety of EBUS in the elderly are similar to the conditions for the general population. There were no significant complications observed including bleeding or arrhythmias.
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Abstract
Chyluria is endemic in the Gangetic belt of India with an average of 90 cases treated annually at our institute. It is almost exclusively caused by Wuchereria bancrofti in tropical areas. Chylomicrons and triglycerides are lost in the urine from an abnormal lymphourinary fistula due to obstructive lymphatic stasis, most commonly at the renal pelvis. It is a distressingly recurrent condition with multiple exacerbations and remissions over years. Severe weakness, weight loss and haematuria occur in some patients. Diagnosis can be made by visual examination of milky urine along with the ether test of urine for chylomicrons. Intravenous urography is used to locate the site of the fistula, although the detection rate is poor. Treatment starts with conservative measures such as a high-protein low-fat diet and diethylcarbamazine therapy. In cases where conservative measures fail, endoscopic sclerotherapy (renal pelvic instillation of silver nitrate, povidone iodine or others) and surgical therapy are used.
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Affiliation(s)
| | - Nikhil Ranjan
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neha Singh
- Department of Pathology, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Keshri Amit
- Department of Surgery, SRMS-IMS, Bareilly, Uttar Pradesh, India
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Reddy DL, Venter WDF, Pather S. Patterns of Lymph Node Pathology; Fine Needle Aspiration Biopsy as an Evaluation Tool for Lymphadenopathy: A Retrospective Descriptive Study Conducted at the Largest Hospital in Africa. PLoS One 2015; 10:e0130148. [PMID: 26091519 PMCID: PMC4474830 DOI: 10.1371/journal.pone.0130148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background Lymphadenopathy is a common clinical presentation of disease in South Africa (SA), particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) co-infection. Methods Data from 560 lymph node biopsy reports of specimens from patients older than 12 years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010 and 31 December 2012 was extracted from the National Health Laboratory Service (NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also extracted from the NHLS. Consent was not obtained from participants for their records to be used as patient information was anonymized and de-identified prior to analysis. Results The majority of patients were female (55%) and of the African/black racial group (90%). The median age of patients was 40 years (range12–94). The most common indication for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained), followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy constituted the largest biopsy pathology group (39%), with 36% of this group being carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed necrotizing granulomatous inflammation (including histopathology and cytology demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV reactive nodes; in the remainder no specific pathology was identified (nonspecific reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 2.5% of lymph node pathology in this sample. Concomitant lymph node pathology was diagnosed in four cases of nodal KS (29% of the subset). The co-existing pathologies were TB and Castleman disease. HIV positive patients constituted 49% of this study sample and the majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIV negative and in the remaining nodes, the HIV status of patients was unknown. The most common lymph node pathologies in HIV positive patients were Mycobacterial infection (31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific reactive lymphoid hyperplasia (15%). Only 8.7% were of Hodgkin lymphoma. In contrast, the most common lymph node pathologies in HIV negative patients were nonspecific reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection (11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9% and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in the HIV positive group compared to the HIV negative group. FNA and lymph node biopsy had statistically significant good agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07, 95% CI 0.606-0.882, p=0.001), non-Hodgkin lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE 0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07, 95% CI 0.618-0.833, p=0.001). Conclusions The most common lymph node pathologies in CHBAH are malignancies, nonspecific reactive lymphoid hyperplasia, necrotizing granulomatous inflammation and HIV reactive nodes. The distribution of disease differs in HIV positive patients. Overall, adequate FNA samples of lymph nodes have been found to have good correlation with lymph node biopsy findings in our setting.
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Affiliation(s)
- Denasha Lavanya Reddy
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Willem Daniel Francois Venter
- Wits Reproductive Health and HIV Institute (RHI) Associate Professor, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sugeshnee Pather
- Division of Anatomical Pathology, School of Pathology, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ha GW, Lee MR. Surgical repair of intractable chylous ascites following laparoscopic anterior resection. World J Gastroenterol 2015; 21:6077-6081. [PMID: 26019476 PMCID: PMC4438046 DOI: 10.3748/wjg.v21.i19.6077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficient in patients with chylous ascites after surgery. However, we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery.
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Abstract
IgG4-related disease is a newly recognized entity associated with autoimmune conditions involving almost every organ system. It is characterized by elevated serum IgG4 as well as mass like tissue infiltration by IgG4-positive plasma cells. Imaging findings are nonspecific, vary depending on the site of disease, and include mass like enlargement of the salivary or lacrimal glands and enlarged lymph nodes. Radiographic findings often mimic malignancy, necessitating tissue sampling to confirm the diagnosis. Distinguishing IgG4-related disease from malignancy is important as IgG4 responds well to steroids and conservative management.
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Affiliation(s)
- Tyler McKinnon
- Department of Radiology, Georgia Regents University, Augusta, GA, USA
| | | | - Brian D Kim
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - Paul Biddinger
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - Scott Forseen
- Department of Radiology, Georgia Regents University, Augusta, GA, USA
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Mastan S, Advani R, Stobbs N, Kumar N. A rare manifestation of a multisystemic disease: a case of vocal cord palsy secondary to sarcoidosis. BMJ Case Rep 2015; 2015:bcr2015209728. [PMID: 25917073 PMCID: PMC4422924 DOI: 10.1136/bcr-2015-209728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/04/2022] Open
Abstract
We describe a rare case of recurrent laryngeal nerve neuritis secondary to sarcoidosis. A 40-year-old woman presented with persistent dysphonia. This was her first episode of dysphonia with no reports of laryngeal trauma. Fibre-optic laryngoscopy revealed a normal nasal passage, nasopharynx and pharynx. The supraglottic structures were all unremarkable; however, inspection of the true vocal cords revealed a left vocal cord palsy that was identified as being in a paramedian position. Radiological investigation showed mediastinal adenopathy that measured up to 20 mm in the short axis diameter. Histological examination showed granulomatous lymphadenitis of the lymph node with a central area of sclerosis surrounded by discrete, non-caseating granuloma. Stains for acid-fast bacilli were negative. The morphological features were suggestive of sarcoidosis. The lymphadenopathy distribution and size did not suggest left recurrent laryngeal nerve compression, giving a subsequent diagnosis of recurrent laryngeal nerve neuritis secondary to sarcoidosis.
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Affiliation(s)
- Saleem Mastan
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Rajeev Advani
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Nicola Stobbs
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Nirmal Kumar
- Department of ENT, Royal Albert Edward Infirmary, Wigan, UK
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Chiesa A, Acciarri L. Thermography of the neck. Adv Otorhinolaryngol 2015; 24:143-65. [PMID: 629161 DOI: 10.1159/000400902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Taillens JP. Cervical adenopathies. Fortschr Hals Nasen Ohrenheilkd 2015:64-112. [PMID: 4894143 DOI: 10.1159/000385359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Erlij D, Ramos D, Montaña J, Kusnir P, Correa G, Neira O. [IgG4-related disease, the new "great mimicker": report of one case]. Rev Med Chil 2015; 142:646-50. [PMID: 25427023 DOI: 10.4067/s0034-98872014000500014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/01/2014] [Indexed: 11/17/2022]
Abstract
Due to its multisystem involvement, IgG4 -related disease should be considered in the differential diagnosis of medical conditions such as lymphadenopathies, aortitis, serositis and retroperitoneal fibrosis. It shares features with other entities historically described as "great mimickers" such as syphilis, tuberculosis, sarcoidosis, and systemic lupus erythematosus. We report a 40 year-old male with recurrent effusive - constrictive pericarditis, lymphadenopathy and aortitis. The study revealed an inactive tuberculosis with negative cultures for acid fast bacilli. The patient had high serum levels of IgG4 and a mediastinal lymph node biopsy was consistent with IgG4 -related disease. The patient was treated with prednisone 40 mg/day with an excellent response.
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John CC, Bingi KK, Brant RW, Costello LM, Livengood RH. An 18-year-old with recurrent Fever, night sweats, and lymphadenopathy. Macrophage activation syndrome. Pediatr Ann 2015; 44:146-8. [PMID: 25875979 DOI: 10.3928/00904481-20150410-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bourrillon A, Doz F, de Jaureguiberry JP. [Superficial lymph nodes of the child]. Rev Prat 2015; 65:555-560. [PMID: 26058210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sreedharanunni S, Sachdeva MUS, Malhotra P, Ahluwalia J, Naseem S, Prakash G, Khadwal A, Sharma P, Kumar N, Varma N, Varma S, Das R. Role of blood and bone marrow examination in the diagnosis of mature lymphoid neoplasms in patients presenting with isolated splenomegaly. ACTA ACUST UNITED AC 2015; 20:530-7. [PMID: 25760312 DOI: 10.1179/1607845415y.0000000005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Mature lymphoid neoplasms presenting with 'prominent splenomegaly without significant lymphadenopathy' are uncommon and pose unique diagnostic challenges as compared to those associated with lymphadenopathy. Their descriptions in the literature are largely limited to a few case series. We analyzed the spectrum of these lymphomas diagnosed by peripheral blood (PB) and/or bone marrow (BM) examination. METHODS Over a period of 6 years, 75 patients were diagnosed with a lymphoma from PB/BM who had presented with predominant splenomegaly. Their clinical and laboratory records including PB and BM morphology; immunophenotyping using multi-parametric flow-cytometry and immunohistochemistry were reviewed. Wherever indicated, an extended panel of immunohistochemistry (IHC) was performed on BM biopsies for accurate sub-classification. RESULTS AND DISCUSSION The commonest lymphomas were hairy cell leukemia (HCL) (32%) and splenic marginal zone lymphoma (SMZL) (24%). Others included diffuse large B cell lymphoma (8%), chronic lymphocytic leukemia/small lymphocytic lymphoma (8%), mantle cell lymphoma (2.7%), and follicular lymphoma (1.3%), all of which usually presents with lymphadenopathy. SMZL was the commonest lymphoma among females and those with massive splenomegaly and lymphocytosis; while HCL was commonest in patients with pancytopenia. SMZL commonly presented with lymphocytosis; however, 22% of them also presented with pancytopenia. CONCLUSION The high diagnostic efficacy of PB and BM examination using flow-cytometry and immunohistochemistry in confirming and sub-classifying splenic lymphomas suggests that a thorough hematological evaluation should always precede a diagnostic splenectomy. Immunohistochemistry remains the best modality to identify sparse or intra-sinusoidal infiltration on BM biopsy and is particularly useful in patients with fibrotic marrows and pancytopenia.
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MESH Headings
- Adolescent
- Adult
- Aged
- Bone Marrow/pathology
- Diagnosis, Differential
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukocytes, Mononuclear/pathology
- Lymphatic Diseases/diagnosis
- Lymphatic Diseases/pathology
- Lymphocytosis/diagnosis
- Lymphocytosis/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Pancytopenia/diagnosis
- Pancytopenia/pathology
- Retrospective Studies
- Splenic Neoplasms/diagnosis
- Splenic Neoplasms/pathology
- Splenomegaly/diagnosis
- Splenomegaly/pathology
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Muyanja D, Kalyesubula R, Namukwaya E, Othieno E, Mayanja-Kizza H. Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients. Afr Health Sci 2015; 15:107-16. [PMID: 25834538 DOI: 10.4314/ahs.v15i1.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. OBJECTIVE The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. METHODS We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. RESULTS We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. CONCLUSIONS Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.
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Affiliation(s)
- David Muyanja
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mengo Hospital, Department of Medicine, Kampala, Uganda
| | - Robert Kalyesubula
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mulago National Referral Hospital, Kampala, Uganda ; Department of Physiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth Namukwaya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mulago National Referral Hospital, Kampala, Uganda ; Mulago Palliative Care Unit, Kampala, Uganda
| | - Emmanuel Othieno
- Mulago National Referral Hospital, Kampala, Uganda ; Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda
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