LYMPHADENITIS
 

Selected abstracts:

1.            Barnett K, Medzon R. Scrofula as a presentation of tuberculosis and HIV. CJEM. 2007 May;9(3):176-9. 

Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA. katrina.barnett@gmail.com

Scrofula, or tuberculous cervical lymphadenitis, though now rare, is more commonly seen in minorities, women and immunosuppressed patients, especially those with HIV. We discuss a patient who presented to the emergency department with an anterior neck abscess and was diagnosed with both advanced HIV and disseminated tuberculosis. A high level of suspicion is necessary to make this diagnosis, but given an increasing degree of global mobility, such patients may present anywhere. Medical management is effective, though difficult. Early diagnosis improves the patient's individual prognosis and may prevent further exposure and transmission to the population.

2.            Groselj-Grenc M, Repse S, Vidmar D, Derganc M. Clinical and laboratory methods in diagnosis of acute appendicitis in children. Croat Med J. 2007 Jun;48(3):353-61.

Department of Pediatric Surgery and Intensive Care, University Medical Center, Ljubljana, Slovenia.

AIM: To compare the diagnostic accuracy of clinical examination, white blood cell and differential count, and C-reactive protein as routine tests for acute appendicitis with that of interleukin-6 (IL-6) and ultrasonography. METHODS: Eighty-two children were admitted to the Department of Pediatric Surgery and Intensive Care, Ljubljana, Slovenia because of suspected acute appendicitis. Among them, 49 children underwent surgery for acute appendicitis and 33 had abdominal pain but were not treated surgically and were diagnosed with non-specific abdominal pain or mesenteric lymphadenitis on sonography. Clinical signs of acute appendicitis were determined by surgeons on admission. White blood cell count and differential and serum concentrations of C-reactive protein and IL-6 were measured and abdominal ultrasonography was performed. RESULTS: Ultrasonography showed the highest diagnostic accuracy (92.9%; 95% confidence interval [CI], 84.5%-98.0%, Bayes' theorem), followed by serum IL-6 concentration (77.6%; 67.1-86.1%, receiver-operating characteristic [ROC] curve analysis), clinical signs (69.5%; 59.5-79.0%, Bayes' theorem), white blood cell count (68.4%; 57.2-78.3%, ROC curve analysis), and serum C-reactive protein concentration (63.7%; 52.174.3%, ROC curve analysis). Ultrasonography achieved also the highest specificity (95.2%) and positive (93.8%) and negative (93.3%) predictive values, whereas clinical signs showed the highest sensitivity (93.9%). CONCLUSION: Ultrasonography was a more accurate diagnostic method than IL-6 serum concentration, laboratory marker with the highest diagnostic accuracy in our study, and hence it should be a part of the diagnostic procedure for acute appendicitis in children.

3.            Kim BM, Kim EK, Kim MJ, Yang WI, Park CS, Park SI.  Sonographically guided core needle biopsy of cervical lymphadenopathy in patients without known malignancy. J Ultrasound Med. 2007 May;26(5):585-91.

Department of Diagnostic Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea.

OBJECTIVE: The purpose of this study was to retrospectively evaluate the efficacy of sonographically guided core needle biopsy (core biopsy) for diagnosing the causes of cervical lymphadenopathy in patients without known malignancy. METHODS: One hundred fifty-five sonographically guided core biopsies performed in 155 patients with cervical lymphadenopathy were retrospectively evaluated. None of the 155 patients had any known primary malignancy. Final diagnoses were determined by the histologic examination from excision biopsy when performed or by the clinical and sonographic follow-up for more than 12 months. When a lymph node diagnosed as benign by sonographically guided core biopsy regressed spontaneously or by subsequent management, the diagnosis made by the sonographically guided core biopsy was considered correct. When a lymph node diagnosed as benign by sonographically guided core biopsy was unchanged or increased in size with subsequent management, excision biopsy was performed. Diagnostic yield, sensitivity, specificity, accuracy, and complications of core biopsy were evaluated. RESULTS: Histologic diagnosis could be made by sonographically guided core biopsy in 146 (94%) of the 155 patients. The histologic diagnoses were reactive hyperplasia in 44 patients, tuberculosis in 37, Kikuchi disease in 25, metastasis in 16, lymphoma in 16, normal in 7, and toxoplasmosis in 1. Sensitivity, specificity, and accuracy of sonographically guided core biopsy were 97.9%, 99.1%, and 97.9%, respectively. There were no procedure-related complications. CONCLUSIONS: Sonographically guided core biopsy is a safe and efficient tool for diagnosing the cause of cervical lymphadenopathy in patients without known malignancy and may obviate unnecessary excisional biopsy.

4.            Sharma M, Agarwal S, Wadhwa N, Mishra K, Gadre DJ. Spectrum of cytomorphology of tuberculous lymphadenitis and changes during anti-tubercular treatment. Cytopathology. 2007 Jun;18(3):180-3. 

Department of Pathology, University College of Medical Sciences, Delhi, India.

OBJECTIVE: To analyse the morphological changes in tuberculous lymph nodes and the clinical response during short course anti tubercular chemotherapy. METHODS: Thirty-six patients with tuberculous lymphadenitis under treatment were followed up clinically and cytologically at 0, 2, 4 and 6 months. RESULTS: Twenty-six (72.2%) patients had palpable lymph nodes at the end of chemotherapy. Of the 14 patients with residual lymph nodes exceeding 1 cm in size, 92.8% (13) still had evidence of continuation of the disease. Acid-fast bacilli could be found in 38.8% patients at the end of 6 months. Intense lymphocytic infiltration of granulomata in the early phase of chemotherapy predicted a favourable outcome. CONCLUSIONS: Following completion of anti-tubercular treatment a significant percentage of patients have persistent lymphadenopathy and harbour the disease. Morphological follow up of these patients is essential as they may be at increased risk of relapse.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

16414.  Enomoto K, Hoshida Y, Hamada K, Okada T, Kubo T, Hatazawa J. F-18 FDG PET imaging of cervical tuberculous lymphadenitis. Clin Nucl Med. 2007 Jun;32(6):474-5. 

16415.  Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol. 2007 Jun;71(6):943-8.

16416.  Pepper S, Islam HK, Jayabose S, Ozkaynak MF, Tugal O, Sandoval C. Neuroblastoma masquerading as cervical lymphadenitis. J Pediatr Hematol Oncol. 2007 Apr;29(4):260-1.

Chemotherapy, Immunotherapy, Management & Drugs:

16417.  Gupta KB, Kumar A, Sen R, Sen J, Vermas M. Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis. Indian J Tuberc. 2007 Apr;54(2):71-8.