Lymphadenitis
(Diagnosis, Diagnostics, Immunodiagnosis,
Immunodiagnostics, Pathogenesis, Vaccines
& Drugs)
ABSTRACTS
1319. Desai
C. Kumar KS. Rao P. Thapar V. Supe AN. Spontaneous oesophageal perforation
due to mediastinal tuberculous lymphadenitis - atypical presentation of
tuberculosis. Journal of Postgraduate Medicine. 45(1):13-4, 1999 Jan-Mar.
Abstract
Spontaneous non-traumatic oesophageal perforation secondary to
bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The
diagnosis is delayed, as perforation remains localised due to mediastinal lymph
nodes. Patient can be effectively managed by paraoesophageal drainage of the
mediastinal abscess and oesophageal diversion.
1320. Maltezou
HC. Spyridis P. Kafetzis DA. Tuberculosis during
infancy. International Journal of
Tuberculosis & Lung Disease.
4(5):414-9, 2000 May.
Abstract
SETTING: A worldwide re-emergence of tuberculosis has been observed during the last decade. However, few studies of infants with tuberculosis appear in the literature. OBJECTIVE: To describe tuberculosis during infancy. DESIGN: The records of all infants diagnosed with tuberculosis at a tertiary care hospital from 1982 to 1998 were reviewed. RESULTS: Thirty-nine infants with a median age of 10 months were identified, 59% of whom presented during the second half of the study period. Diagnoses included endothoracic tuberculosis (33 patients), meningitis (3), miliary tuberculosis (2) and cervical lymphadenitis (1). Reasons for medical evaluation were the onset of symptoms (25 patients), contact investigation (12) and tuberculin skin test screening (2). Common signs and symptoms included fever (22 patients), cough (7), appetite loss (4) and wheezing/rales (4). Chest X-ray revealed hilar adenopathy (22 patients), infiltrates (16), atelectases (3) and miliary pattern (2). Cultures were attempted in nine patients and were positive in seven. All patients responded promptly to treatment. No complications or deaths occurred. CONCLUSION: Tuberculosis in infants has been diagnosed increasingly during the last decade. Endothoracic tuberculosis predominates. One third of the patients were diagnosed due to contact investigation. As early diagnosis and treatment appears to prevent complications and reduce mortality, pediatricians should be alert for tuberculosis in an infant with an atypical picture suggestive of infection.
1321. Monchy D. Noellat P. Nomoredjo A. Videault A. Dubourdieu D.Nodular breast filariasis: diagnosis by fine needle aspiration. Pathology International. 46(3):228-30, 1996 Mar.
Abstract:Bancroftian filariasis is
a tropical disease transmitted by mosquitoes that
most often causes
lymphadenitis. This article reports on a breast
nodule due to Wuchereria
bancrofti in a woman living in New Caledonia. The
diagnosis was done by fine needle aspiration, which showed several
microfilariae and avoided
surgical treatment.
1322. Rameshkumar K. Tuberculous lymphadenitis in children--role of fine needle aspiation cytology. Journal of the Association of Physicians of India. 47(10):976-9, 1999 Oct.
Abstract
OBJECTIVES: Tuberculosis in children remains misdiagnosed, underdiagnosed or paradoxically overtreated as a result of diagnostic difficulties and non-specific manifestations such as lymphadenopathy. The aims of the study were, i) To assess the efficiency of fine needle aspiration cytology (FNAC) in comparison to histology to determine the prevalence of tuberculosis in lymph nodes, ii) To compare the cytological and histopathological features of lymphadenopathy in children to adults, iii) To analyse the clinical significance of the results in the context of diagnosis. MATERIAL AND METHODS: The biopsies of lymph nodes obtained during the seven year period from January 1989 to December 1995 and the lymph nodes on which fine needle aspiration cytology was done during the period, January 1990 to December 1995 were included for the study. Hemotoxylin and Eosin stain was used for basic evaluation of the histopathologic features. A grading system of 0 to 5+ was used to assess the smears to categorise them into diagnostic groups. RESULTS: Among 1396 lymph node biopsies submitted for evaluation of non-neoplastic conditions 54.12% (741) showed tuberculosis, in which children constituted 9.04%. A higher incidence of 68.61% was observed on FNAC. Both on cytology and histology, a necrotizing type of inflammation was observed more in children, which indicated hypersensitivity. CONCLUSION: FNAC was found to be a useful adjunct diagnostic technique especially in children, but the need to develop a sensitive and easily available method to diagnose in asymptomatic and high risk children still persists. Selection of patients with lymphadenopathy for more than three weeks is important, as otherwise nonspecific changes and acute inflammatory changes are likely to interfere with the diagnosis.
1323. Singh KK. Muralidhar M. Kumar A. Chattopadhyaya TK. Kapila K. Singh MK. Sharma SK. Jain NK. Tyagi JS. Comparison of in house polymerase chain reaction with conventional techniques for the detection of Mycobacterium tuberculosis DNA in granulomatous lymphadenopathy. Journal of Clinical Pathology. 53(5):355-61, 2000 May.
Abstract
AIMS: To evaluate the usefulness of the devR based polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis in lymph node aspirates and tissues of lymphadenitis and to compare PCR with conventional diagnostic techniques. SUBJECTS AND METHODS: Coded specimens of fine needle aspirates and biopsies from 22 patients with tuberculous lymphadenitis, 14 patients with non-tubercular lymphadenitis, and nine patients with granulomatous lymphadenitis were processed and subjected to analysis by PCR, smear microscopy, M tuberculosis culture, histology, and cytology. RESULTS: Tuberculous lymphadenitis was correctly diagnosed by PCR in 18 patients, by culture in five patients, by histology in 13 patients, and by cytology in seven patients. PCR gave two false positive results in 14 patients with non-tubercular lymphadenitis. The sensitivity of the conventional techniques was significantly higher with biopsies (17 of 22 specimens; 77%) than with fine needle aspirates (nine of 22 specimens; 41%). However, the sensitivity of PCR was not significantly higher with biopsies (68%) in comparison with fine needle aspirates (55%). The sensitivity of either biopsy PCR or fine needle aspirate PCR was not significantly different from that of either histology combined with culture or cytology combined with culture. The overall combined specificity of PCR was 86%. Mycobacterium tuberculosis DNA was detected in six of nine patients with granulomatous lymphadenitis. CONCLUSION: PCR is the most sensitive single technique available to date for the demonstration of M tuberculosis in specimens derived from patients with a clinical suspicion of tuberculous lymphadenitis. The value of PCR lies in its use as an adjunct test in the diagnosis of tuberculous lymphadenitis, particularly in those patients where conventional methods fail. Because fine needle aspiration is not an invasive procedure, it is the procedure of choice, and PCR should be performed initially on these samples. Excisional biopsy histology and PCR should be recommended only for patients in whom fine needle aspirate PCR is negative or when there is discrepancy with the clinical impression.
1324. Swaminathan
S. Umadevi P. Shantha S. Radhakrishnan
A. Datta M. Sero diagnosis of
tuberculosis in children using two ELISA kits. Indian Journal of
Pediatrics. 66(6):837-42, 1999 Nov-Dec.
Abstract
The diagnosis of childhood tuberculosis is based on circumstantial evidence in the absence of a gold standard in the majority of cases. Sero-diagnosis offers scope for an early diagnosis in a variety of clinical conditions and is simple to perform. A number of mycobacterial antigens have been used for antibody detection assays and several are available as kits in the market. This study was done to evaluate the value of antibody detection kits (ELISA) against the A60 antigen and 38 kDa antigen of Mycobacterium tuberculosis in the diagnosis of childhood tuberculosis at the outpatient department of the Institute of Social Paediatrics, Government Stanley Hospital in collaboration with Tuberculosis Research Centre, Chennai. Thirty five children with pulmonary tuberculosis, 7 with TB lymphadenitis and 22 healthy controls were studied. In addition to routine investigations including gastric lavage for AFB culture, serum antibodies against the A60 and 38 kDa antigens were assayed using commercially available ELISA kits. With A60, IgM serum levels were positive in 74% of pulmonary TB cases, 57% of TB lymphadenitis cases and 50% of controls. A60 IgG was positive in 17% of pulmonary TB, 86% of TB lymphadenitis and 14% of controls. The 38 kDa IgG antibody was positive in 37% of pulmonary and 86% of TB lymphadenitis cases and 27% of controls. Among 10 culture confirmed cases, A60 IgM was positive in 8, A60 IgG in 3 and 38 kDa IgG in 5 patients. The sensitivity of the tests ranged between 29% and 71% and specificity between 50% and 86%. Although the numbers are small, the results suggest that serodiagnosis using the currently available antigens of M. tuberculosis is unlikely to be a confirmatory test for tuberculosis in children.
1325. Weiler
Z. Nelly P. Baruchin AM. Oren S.
Diagnosis and treatment of cervical tuberculous lymphadenitis. Journal of Oral
& Maxillofacial Surgery.
58(5):477-81, 2000 May.
Abstract
PURPOSE: This study
presents the long-term results of treatment of a
series of patients with
tuberculous mycobacterial lymphadenitis of the
head and neck. PATIENTS: Twenty-one patients were seen in a 10-year
period. The median age at
onset was of 41.2 years (range, 4 to 79 years),
and the male-to-female ratio
was 11:10. Sixteen patients were of Ethiopian
origin, 3 from the former
USSR, and 2 were Israeli women (1 of Indian and
1 of Morrocan origin).
Symptoms started between 2 weeks and 6 months
before presentation
(mean, 5.8 weeks). Most patients had negative chest
radiographs, a variable
response to the tuberculin skin test, and a negative culture for
mycobacterial organisms. RESULTS: Fine-needle
aspiration (FNA) of the
cervical lymph nodes was the most reliable method
to confirm the bacteriologic
agent causing the lymphadenopathy. Acid-fast bacilli smears of the
aspirate were positive in all but 3 patients,
whereas histologic
examination of the lymph nodes gave diagnostic results in only two thirds of
cases examined. All patients were treated with
antituberculous chemotherapy. Sixteen patients also underwent surgical
excision of their
cervical lymph nodes, and all of them showed a complete
response to the combined
treatment. The remaining patients reacted to chemotherapy alone with
complete cure. One patient died of gastric carcinoma, and the only
acquired immune deficiency syndrome (AIDS) patient
died a year later of
cytomegalovirus encephalitis. CONCLUSION: The most
reliable indicator of
cervical mycobacterial infection is an acid-fast
smear from the FNA specimen. Antituberculous chemotherapy, with or without
surgical excision of the involved cervical lymph nodes, is the method of
choice for treatment of
this disease.
1756.
Authors
Dercksen DP. Brinkhof JM. Dekker-Nooren
T. Maanen K. Bode CF. Baird
G.
Kamp EM.
Title
A comparison of four serological tests for
the diagnosis of caseous
lymphadenitis in sheep and goats.
Source
Veterinary Microbiology. 75(2):167-75, 2000 Jul 31.
Abstract
A double antibody sandwich ELISA (ELISA A)
developed for the detection of Corynebacterium pseudotuberculosis infection
in sheep and goats was modified to improve its sensitivity. To
establish the sensitivity and specificity of this modified ELISA (ELISA
B), sera from 183 sheep and 186 goats were tested using ELISAs A and B. Comparison was also made with two
further ELISAs (C and D) developed in
Australia that, respectively, detect antibodies to cell wall antigens or
toxin.ELISA B had the best performance of the four tests. Its specificity was
98+/-1% for goats and 99+/-1% sheep. Its sensitivity was 94+/-3% for goats
and 79+/-5% for sheep. ELISA B will now be tested for use in caseous
lymphadenitis eradication and control programmes in The Netherlands. It
will also be used in experimental studies of CL in Scotland.
1757.
Authors
Flint D.
Mahadevan M. Barber C. Grayson D.
Small R.
Title
Cervical lymphadenitis due to
non-tuberculous mycobacteria: surgical
treatment and review. [Review] [41 refs]
Source
International Journal of Pediatric
Otorhinolaryngology. 53(3):187-94,
2000 Jul 14.
Abstract
A retrospective study was carried out on 57
children, presenting with non-tuberculous mycobacterial (NTM)
lymphadenitis of the head and neck, over a 12 year period. Cultures recovered 56
Mycobacterium avium-intracellulare (MAI), and one
Mycobacterium kansasaii. Anti-mycobacterial agents were used in seven
patients only. On the basis of the initial operation there were two
groups. Group 1 (11 patients) had an excision, and Group 2 (46 patients) had
incision and drainage (30 patients), incision and curettage (13
patients), or aspiration (three patients). There was no significant difference in the makeup of these two
groups. However, Group 1 had significantly
lower number of re-operations than Group 2, P<0.01, and achieved a
significantly greater healing rate than Group 2, P<0.001. In Group 2 those
who had an excision following failure of the first operation were
significantly more likely to heal than those who did not, P<0. 005. Operative
excision gives a lower rate of re-operation, and a higher rate of healing
than other procedures. The treatment, natural history, clinical presentation, pathogenesis, and
diagnosis of NTM cervical lymphadenitis are
discussed. [References: 41]
1758.
Authors
Ganesan S.
Thirlwall A. Brewis C. Grant HR.
Novelli VM.
Title
Dual infection with atypical mycobacteria
and Mycobacterium tuberculosis
causing cervical lymphadenopathy in a child.
Source
Journal of Laryngology & Otology. 114(8):649-51, 2000 Aug.
Abstract
The most common presentation of mycobacterial infection encountered in otolaryngological practice is cervical lymphadenitis. We report a child with an unusual cause of cervical lymphadenopathy, i.e. dual tuberculous infections. This had clinical ramifications as, initially Mycobacterium avium-intracellulare was grown in culture and was resistant to standard anti-tuberculous agents, and hence treated with excision of the lymph node. However, the cultures from the excised lymph node grew out Mycobacterium tuberculosis that was sensitive to standard anti-tuberculous drugs. To our knowledge, no such presentation has been reported previously. We also review the literature on cervical lymphadenitis due to atypical mycobacteria and Mycobacterium tuberculosis, with particular emphasis on clinical presentation, diagnosis and management.
1759.
Authors
Kwon KS.
Oh CK. Jang HS. Lee CW.
Jun ES.
Title
Detection of mycobacterial DNA in cervical
granulomatous lymphadenopathy
from formalin-fixed, paraffin-embedded
tissue by PCR.
Source
Journal of Dermatology. 27(6):355-60, 2000 Jun.
Abstract
Cervical tuberculous lymphadenitis is the
most common form of inflammatory neck mass in Korea. The diagnosis of
tuberculosis requires proof of the presence of Mycobacterium tuberculosis by
acid-fast staining or bacterial growth in culture. However, these are often
difficult in cervical tuberculous lymphadenitis. The aim of this
study was to investigate the value of the polymerase chain reaction (PCR)
technique for detection of mycobacteria in routinely processed tissue
sections of cervical granulomatous lymphadenopathy. In this
retrospective study, twenty formalin-fixed, paraffin-embedded biopsy
specimens from clinically and/or histopathologically diagnosed cervical
granulomatous lymphadenopathy were analyzed for mycobacterial DNA by PCR. Two
different primers to amplify mycobacterial-common 383-base pair (bp) DNA
and Mycobacterium tuberculosis-complex-specific 123-bp DNA
were used. Positive PCR products were sequenced directly.
Mycobacterial-common DNA (383-bp positive) was found in 10 of the 20 cases. Among them, 7
cases were PCR positive with
both
primer sets. These seven cases can be considered as tuberculosis. The other three cases indicated possible
atypical mycobacteriosis. PCR is a useful technique for the demonstration of
mycobacterial DNA fragments in patients with clinically suspected cervical
tuberculous lymphadenitis who have acid fast-negative histology and/or unsuccessful mycobacterial
cultures.
1760.
Authors
Lillebaek T. Thomsen VO.
Title
A patient with suspected sarcoidosis died
from miliary tuberculosis.
Source
Scandinavian Journal of Infectious
Diseases. 32(2):218-20, 2000.
Abstract
In Western Europe, awareness of tuberculous
lymphadenitis (TLA) has declined. This report describes a patient
who had suspected sarcoidosis for 3.5 y, who eventually died from miliary
tuberculosis due to delay in diagnosis. The report includes a discussion
of the differential diagnosis of TLA and sarcoidosis.
1761.
Authors
Mahadeva U.
Allport T. Bain B. Chan WK.
Title
Haemophagocytic syndrome and histiocytic
necrotising lymphadenitis
(Kikuchi's disease).
Source
Journal of Clinical Pathology. 53(8):636-8, 2000 Aug.
Abstract
A young boy presented with a rash, fever,
and cervical lymphadenopathy, originally thought to be caused by
tuberculosis. A lymph node biopsy showed the features of Kikuchi's disease,
with necrosis and histiocytic infiltration without neutrophils. No
evidence of tuberculosis was found on staining, culture, or the polymerase chain
reaction. Bone marrow biopsy revealed prominent haemophagocytosis, and a
diagnosis of haemophagocytic syndrome was reached. The aetiology of
haemophagocytic syndrome, and its association with Kikuchi's lymphadenitis, is
discussed.
1762.
Authors
Mangold BJ.
Cook RA. Cranfield MR. Huygen K.
Godfrey HP.
Title
Detection of elevated levels of circulating
antigen 85 by dot
immunobinding assay in captive wild animals
with tuberculosis.
Source
Journal of Zoo & Wildlife Medicine. 30(4):477-83, 1999 Dec.
Abstract
Antemortem diagnosis of tuberculosis in
captive wild animals is often difficult. In addition to the variability of
host cellular immune response, which does not always indicate
current active infection, reactivity to saprophytic or other
mycobacteria is common and may interfere with the interpretation of the
intradermal tuberculin skin test. Furthermore, the immobilization required for
administering the test and evaluating skin reactions in these animals
may result in unacceptable levels of morbidity and mortality, of
particular concern in individuals of rare or endangered species. Proteins of the
antigen 85 (Ag85) complex are major secretory products of actively
metabolizing mycobacteria in vitro. Production of these proteins by mycobacteria
during growth in vivo could result in increases in circulating levels of
Ag85 in hosts with active tuberculosis. A dot blot immunoassay has
been used to detect and quantify circulating Ag85 in captive wild animals
with tuberculosis. Elevated levels of Ag85 were observed in animals with
active tuberculosis as compared with uninfected animals. Study
populations included a herd of nyala (Tragelaphus angasi) (n = 9) with no
history of exposure to Mycobacterium bovis. Serum Ag85 levels
ranged from <5 to 15 microU/ ml (median, 5 microU/ml). The other group included 11 animals from a mixed
collection with a documented history of an
M. bovis outbreak. Animals with pulmonary granulomatous lesions (n = 3) had
serum Ag85 levels ranging from 320 to 1,280 microU/ml (median, 320 microU/ml).
Animals with only chronic mediastinal or mesenteric lymphadenitis (n =
4) had serum Ag85 levels ranging from <5 to 320 microU/ml (median,
52.5 microU/ml). Animals with no lesions present on necropsy (n = 4) had
serum Ag85 levels ranging from <5 to 80 microU/ml (median, <5 microU/ml).
This assay could provide an important adjunct to intradermal skin
testing for antemortem diagnosis of tuberculosis in nondomestic species.
1763.
Authors
Mannara GM.
Boccato P. Rinaldo A. La Rosa F.
Ferlito A.
Title
Histiocytic necrotizing lymphadenitis
(Kikuchi-Fujimoto disease) diagnosed
by fine needle aspiration biopsy.
Source
Orl; Journal of Oto-Rhino-Laryngology &
its Related Specialties.
61(6):367-71, 1999 Nov-Dec.
Abstract
A case of histiocytic necrotizing
lymphadenitis involving a right submandibular lymph node is described in a
14-year-old Caucasian boy. The diagnosis was established on initial
assessment by fine needle aspiration biopsy. Excisional biopsy, performed because
the lymph node enlargement failed to regress, confirmed the cytological
findings.
2242. Cignarelli M. Triggiani V. Ciampolillo A. Ambrosi A. Giorgino F. Liso V. Giorgino R. High frequency of incidental diagnosis of extrathyroidal neoplastic diseases at the fine-needle aspiration biopsy of laterocervical lymph nodes in patients with thyroid nodules. Thyroid. 11(1):65-71, 2001 Jan.
Abstract
This study was undertaken to evaluate the frequency of the incidental diagnosis of extrathyroidal lymph node diseases at ultrasound-guided fine-needle aspiration biopsy/cytology (FNAB/C) being done to check the presence of metastatic thyroid cancer in 30 subjects with thyroid nodule (TN) and enlarged cervical lymph nodes (CLN). The patients in whom cytology suggested the presence of malignancy in the TN or in the CLN underwent surgical removal for histologic diagnosis. The spectrum of diseases revealed by this survey included: (1) 10 benign diseases including 1 case of Piringer-Kuchinka lymphadenitis with benign TN; (2) 10 metastatic thyroid cancers (2 anaplastic and 8 papillary cancers); (3) 3 benign TN associated with metastatic invasion of cervical lymph nodes from lung (2 cases) and breast (1 case) cancer; (4) 1 Hodgkin's lymphoma of the cervical lymph nodes with hyperplastic TN; (5) 3 nodal lymphomas with benign thyroid nodule and 2 cases of thyroid lymphoma with nodal invasion; and (6) 1 nodal sarcoidosis with benign TN. The results of this study demonstrate that important neoplastic and hematologic diseases affecting the cervical lymph nodes may frequently be incidentally detected using ultrasonography (US) and FNAB/C in the diagnostic procedure for thyroid nodule.
2243. De Baere T. Moerman M. Rigouts L. Dhooge C. Vermeersch H.Verschraegen G. Vaneechoutte M. Mycobacterium interjectum as causative agent of cervical lymphadenitis. [Review] [16 refs] Journal of Clinical Microbiology. 39(2):725-7, 2001 Feb.
Abstract
A mycobacterial strain isolated from a lymph node of a 3-year-old female with cervical lymphadenitis was identified as Mycobacterium interjectum by means of sequencing of the 16S rRNA gene. Analysis of this case and previously published cases demonstrates the importance of M. interjectum as a causative agent of cervical lymphadenitis in young children. [References: 16]
2244. Jha BC. Dass A. Nagarkar NM. Gupta R. Singhal S. Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management. Postgraduate Medical Journal. 77(905):185-7, 2001 Mar.
Abstract
Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease.All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease.This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.
2245. Kawashima H. Nishimata S. Shimizu T. Kashiwagi Y. Takekuma K.Hoshika
A. Highly suspected case of FAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis) syndrome. Pediatrics International. 43(1):103-6, 2001 Feb.
2246. Malich A. Fritsch T. Mauch C. Boehm T. Freesmeyer M. Fleck M. Anderson R. Kaiser WA. Electrical impedance scanning: a new technique in the diagnosis of lymph nodes in which malignancy is suspected on ultrasound. British Journal of Radiology. 74(877):42-7, 2001 Jan.
Abstract
Differentiation between inflammatory and malignant lymph nodes by ultrasound is difficult. Electrical impedance scanning (EIS) is a new diagnostic tool, so far used primarily for the identification of malignant breast lesions. Cancer cells have altered dielectric properties compared with normal cells, thereby distorting the local electrical field. The induced changes in capacitance and conductivity are measurable using EIS. We evaluated EIS in demonstrating the cause of lymph node enlargement. 51 lymph nodes that were suspicious for malignancy on ultrasound (32 patients, mean age 32 years), with a mean size of 18 mm x 12 mm x 10 mm, were examined. The following lymph node locations were included in the study: cervical, inframandibular, axillary, paraaortic and inguinal. EIS results were compared with histopathological and follow-up findings. 30/34 malignant lymph nodes were correctly detected using EIS, while 14/17 inflammatory or benign lymph nodes were correctly identified as benign by EIS; thus, there were 4/51 false negative and 3/51 false positive cases. The sensitivity was 88.2% and the specificity was 82.4%. Corresponding negative and positive predictive values were 77.8% and 90.9%, respectively. Results from this initial study suggest the potential usefulness of EIS as an adjunctive imaging modality in the differentiation of lymphadenopathy that is equivocal on ultrasound. The best accuracy was obtained in the cervical, axillary and inguinal regions. Owing to technical restrictions of the present system, examination of inframandibular and paraaortic lymph nodes should be limited to special cases.
2247. Mueller PS. Edson RS. Disseminated Mycobacterium abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis: case report and literature review. [Review] [49 refs] Diagnostic Microbiology & Infectious Disease. 39(1):33-7, 2001 Jan.
Abstract
Mycobacterium abscessus is a rapidly growing mycobacterium found in soil and water throughout the world. Disease in immunocompetent patients usually consists of localized skin and soft tissue infections. In contrast, disseminated disease is uncommon, usually presents with rash, and almost always occurs in an immunocompromised host. We describe an unusual case of disseminated M. abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis, but without rash. Our patient responded well to amikacin and clarithromycin therapy. We also review the literature related to the diagnosis and management of this uncommon disease. [References: 49]
2248. Nuovo GJ. Morrison C. Porcu P. Caligiuri MA. Suster S. In situ determination of T-cell receptor beta expression patterns. Journal of Histochemistry & Cytochemistry. 49(2):139-45, 2001 Feb.
Abstract
A definitive diagnosis of T-cell lymphoma may be contingent on the rearrangement profile of the T-cell receptor. This is most accurately done by molecular analysis of the beta-chain of the T-cell receptor (TCR beta) by Southern blotting hybridization that requires unfixed tissue. We describe a reverse transcriptase in situ PCR (RT in situ PCR) method that permits the target-specific direct incorporation of the reporter nucleotide into the different transcripts that comprise the TCR beta, using paraffin-embedded, formalin-fixed tissue. Each of the 25 possible V beta segment rearrangements was documented in three lymph nodes with nonspecific lymphadenitis, with clonal expansion evident in a case of metastatic melanoma. Monoclonal expression was documented in seven tissues diagnostic of a T-cell lymphoma. We analyzed five additional tissues for which a definitive diagnosis of T-cell vs B-cell lymphoma could not be rendered on the basis of histological, immunohistological, and flow cytometric analysis. RT in situ PCR for TCR beta expression with CD3 co-labeling demonstrated which of these lesions was a B-cell-rich T-cell lymphoma. We conclude that the RT in situ PCR methodology will allow the routine determination of monoclonal vs multiclonal expression patterns of the TCR beta using archival paraffin-embedded tissues.(J Histochem Cytochem 49:139-145, 2001)
2249. Shimizu K. Ito I. Sasaki H. Takada E. Sunagawa M. Masawa N. Fine needle aspiration of toxoplasmic lymphadenitis in an intramammary lymph node. A case report. Acta Cytologica. 45(2):259-62, 2001 Mar-Apr.
Abstract
BACKGROUND: Cytologic findings of toxoplasmic lymphadenitis (TL) have been only sporadically reported. Intramammary lymph node is an extremely rare site for TL. CASE: A 47-year-old, healthy, female presented with a breast tumor, which was aspirated. The cytomorphologic features were interpreted as suggestive of TL. Histopathology of the excisional biopsy specimen and subsequent serologic examination confirmed the diagnosis. CONCLUSION: We obtained several characteristic findings in aspiration of TL. Of these, epithelioid cell clusters and monocytoid cells were the most diagnostic.
2832. No Abstract
2833. No Abstract
2834. No Abstract
2835. No Abstract