Enlarged Abdominal Nodes Research Articles

Hematopoietic Stem Cell Transplantation after Posttransplant Lymphoproliferative Disorder

A 16-yr-old girl received liver transplantation for fulminant hepatitis. Aplastic anemia developed, and she received hematopoietic stem cell transplantation (HSCT). Eleven months after liver transplantation, abdominal lymph node enlargement and colon ulcers were observed, and colon biopsy showed posttransplant lymphoproliferative disorder (PTLD). Immunosuppression reduction was attempted, but it produced no therapeutic effect. Fourteen months after liver transplantation, she received a second HSCT due to engraftment failure, and PTLD resolved completely. The second HSCT can serve as cellular therapy for PTLD.

CLL with enlarged Abdominal Lymph Nodes (EAL) Is An Entity with Decreased Response to Fludarabine Containing Regimens.

Abstract 4406We have found only one study aimed to find prognostic significance of abdominal lymph nodes in CLL (E. Montserrat et al, 2007).It was shown that Rai O CLL patients with enlarged abdominal lymph nodes had inferior survival. It merely means that CT scan could early reveal patients with enlarged lymph nodes. This cohort of patients is included in stage 0 only due to the fact of unavailability of CT scan at the times Rai and Binet staging were described (1975, 1977).The aim of the study was to evaluate prognostic significance of abdominal lymph nodes enlargement for the response to FC and FCR Patients and methods71 untreated CLL patients were included according to the intent to treatment by fludarabine containing regimens (FC and FCR). Staging was performed according to Binet system. Stage B and C patients were included. Lymph nodes were revealed by CT and ultrasound before therapy (Lymph nodes more than 10mm in diameter were considered as abnormal and more than 100 mm in diameter were considered as bulky). CD38 was performed by CytoFlow (cut off 30%). Mutation analysis was done with PCR and sequencing (E.Nikitin, Hematological centre, Moscow), (cut off 98%).CR was defined according to NCI criteria.The patients were treated and followed-up by the single team of physicians, there were no losses of follow-us.SPSS - 17 statistical program was used for analysis. ResultsOverall response (OR) was 86% (61 pts), the rate of CR was 55% (39 pts), the rate of PR 31% (22 pts). In the whole group, FC: OR 81%, CR 46%, PR 35%. FCR: OR 91%, CR 67%, PR 24%), median of PFS was 26 mons (21 mons for FC and 35 for FCR, p=0.006). CD38 positivity, unmutated type and stage C had adverse prognostic significance in the whole group (p= 0,04; p=0,05; p=0,02), in FCR subgroups, mutation status and CD38 had marginal significance in FCR(p=0.9, p=0.75).Abdominal lymph nodes were enlarged in 41 pts (58%), 16 pts had bulky EAL(23%). PFS was lower in the group of patients with EAL in comparison to patients without EAL(18 and 48 mons, p 0.001). Difference in PFS has been also revealed in FC and FCR subgroups: 16 and 25 mons, p=0,003 for FC; 22 and 56 mons, p=0,01 for FCR (Fig.1)All fludarabine containing regimens resistant patients appeared to have EAL (10 pts). The duration of CR and PR were longer in patients without EAL(resp.p = 0.03 and 0.06, Fig. 2).The differences of PFS were also studied inside the groups defined by standard prognostic markers.CD38-, EAL+ patients had median PFS of 23mons, CD38-, EAL- patients-median not achieved (p= 0.01)CD 38+EAL+patients had median PFS of 12 mons, CD38+EAL- patients – 30 mons (p=0,04)Thus, CD38+ patients without EAL had even better PFS than CD38- patients with EAL.VH-mut+ EAL+ patients had median PFS of 18 mons, VH-mut+ EAL- patients – 58 mons (p=0,06)VH-mut- EAL+ patients had median PFS of 11 mons, VH-mut- EAL- patients – 18 mons (p=0,06)Thus, unmutated patients wit EAL had similar PFS with mutated patients without EAL.Stage B EAL+ patients had median PFS of 20 mons, Stage B EAL- patients – 58 mons (p=0,004)Stage C EAL+ patients had median PFS of 15 mons, Stage C EAL- patients – 21 mons (p=0,05)Thus, patients with stage B without EAL had PFS four times better, than patients with stage C, EAL+.Median PFS is similar in patients stage B EAL+ and stage C EAL-.The response equal to PR and more than PR after three cycles of chemotherapy was more frequent in patients without EAL (65% vs 18%, p < 0,001) ConclusionEnlarged abdominal lymph nodes(EAL) is an adverse prognostic marker for response both to FC and FCR. Differences in PFS according to EAL were also revealed inside standard prognostics subgroups (mutation status and CD38,stage).Even more, PFS of patients with standard adverse prognostic factors without EAL were similar to patients without standard adverse prognostic with EAL.CLL with EAL is a separate entity of CLL. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Investigation of the Safety and Usefulness of Computed Tomography-Guided Percutaneous Needle Biopsy of Paraaortic Lymph Nodes.

Abstract 5027 BackgroundVarious factors such as malignant lymphoma cause abdominal lymph node enlargement. A histological diagnosis of malignant lymphoma is important in planning therapy, and although superficial lymph node biopsies are often obtained, target lesions occasionally arise only around the abdominal aorta. These require surgical, or more recently, endoscopic biopsies. To intraoperatively determine whether target lymph nodes are correctly resected during a surgical biopsy can be difficult, and therapy could be delayed due to postoperative complications. ObjectiveTo assess the safety and effectiveness of percutaneous biopsy of paraaortic lymph nodes under computed tomography (CT) fluoroscopic guidance. Subjects and MethodsWe retrospectively investigated puncture success rates based on findings of diagnostic imaging, size of target lymph nodes, rate of confirmed diagnosis, frequency of changes in therapeutic plans and incidence of complications among 36 patients after percutaneous needle biopsy using an 18G cutting needle between September 2002 and March 2009. ResultsThe pre-biopsy diagnoses for the 36 subjects who underwent percutaneous needle biopsy included: malignant lymphoma (n = 26), lymph node metastasis of esophageal cancer (n = 3), lymph node metastasis of lung cancer (n = 3), lymph node metastasis of pancreatic cancer (n = 3) and unknown (n = 3). The median size of the target lymph nodes was 25 mm (range: 9–102 mm). The results of diagnostic imaging indicated that all punctures were successful. The diagnoses were confirmed in 33 of the 36 patients (91.7%). Histopathological findings confirmed malignant lymphoma (n = 21; Follicular Lymphoma in 11 patients, Diffuse Large B cell Lymphoma in 8, T-Cell Lymphoma in 1, Hodgkin Disease in 1), squamous cell carcinoma (n = 2), poorly differentiated adenoma (n = 2), other malignancies (n = 5), benign lesions (n = 3) and unknown in 3. Therapeutic strategies were altered based on the results of CT-guided percutaneous needle biopsies in 12 of the 36 patients (33.3%). Three patients developed 4 adverse events comprising grade 1 radiation dermatitis (n = 1), grade 1 hematoma (n = 2) and grade 1 pneumothorax (n = 1). ConclusionsTarget paraaortic lymph nodes can be accurately punctured using CT-guided percutaneous needle biopsy, and the specimens were too small to examine the flowcytometry or chromosome analysis, however it was enough to confirmed the diagnosis according to WHO classification of malignant lymphoma. Percutaneous biopsy of paraaortic lymph nodes under CT fluoroscopic guidance is useful for confirming diagnoses with a low risk of serious deep organ damage. DisclosuresNo relevant conflicts of interest to declare.

Peripheral T-cell lymphoma presenting as an ischemic stroke in a 23-year-old woman: a case report and review of the literature

IntroductionPeripheral T-cell lymphoma of the unspecified variant is a highly aggressive subtype of T-cell non-Hodgkin's lymphoma. This is the first reported case of this type of lymphoma presenting as an ischemic stroke in a woman.Case presentationA previously healthy 23-year-old woman presented with fever and hemiplegia. She was subsequently intubated after scoring 7 out of 15 at the Glasgow Coma Scale. Brain computed tomography scans of the patient depicted a massive sylvian infarction while an abdominal computed tomography scan revealed multiple enlarged abdominal lymph nodes and a retroperitoneal mass adjacent to the left psoas muscle. A diagnostic work up for inherited thrombophilia yielded negative results. Blood and cerebrospinal fluid cultures for infectious agents also gave negative results. A biopsy of the retroperitoneal mass guided by computed tomography was inconclusive. A biopsy of an enlarged inguinal lymph node of the patient, combined with an immunophenotypic analysis, revealed an unspecified variant of peripheral T-cell lymphoma. The patient underwent chemotherapy but developed multiple organ failure. She died 26 days after she was admitted to our intensive care unit.ConclusionPeripheral T-cell lymphoma of the unspecified variant is a highly aggressive subtype of peripheral T-cell lymphomas. The latter exhibit no consistent immunophenotypic, genetic, or clinical features. Clinicians should be aware of atypical clinical presentations of the above lymphomas such as ischemic stroke.

Follicular lymphoma with marked infiltration of eosinophils

Eosinophilia and tissue infiltration by eosinophils are frequent findings in Hodgkin lymphoma, but they are extremely rare in B-cell lymphoma. Reported herein is a case of follicular lymphoma with extensive lymph node infiltration by eosinophils. The patient was a 71-year-old woman who had a mass in the vicinity of the pancreas found on routine ultrasonography. Subsequent CT indicated several enlarged abdominal lymph nodes, although superficial lymph nodes were not palpable. Two swollen mesenteric lymph nodes were excised to determine the cause of the lymphadenopathy. Histology indicated extensive infiltration of numerous eosinophils to the interfollicular area, especially in the dilated sinuses. The lymphoid follicles were relatively small, had inconspicuous germinal centers, and were scattered between dilated sinuses. Based on the histology, immunohistochemistry, and chromosomal abnormality, a diagnosis of follicular lymphoma was made. Expression of interleukin-3 (IL-3), IL-5, eotaxin, eotaxin-2, and eotaxin-3 was investigated on reverse transcription-polymerase chain reaction of the lymph node tissue, but none of the mRNA expression levels were elevated. This was a unique case of follicular lymphoma with extensive eosinophil infiltration, and to the best of the authors' knowledge this is the first such case ever reported.

Congenital Asplenia and Severe Visceral Toxocariasis

To the Editors: Infection of humans with the larvae of Toxocara canis leads to toxocariasis, one of the most common ascariases. The prevalence in humans ranges between 1 and 4% of the adult population in Western Europe and 60% of children in developing countries.1 Playground sandboxes and domestic canines represent major sources of infection. Geophagia is an important risk factor in children, documented to be etiologic in 10–30% of cases. Visceral larva migrans is the clinical term for Toxocara infection associated with major organs. Generally, it is considered a self-limited disease. Previous reports have demonstrated varied presentations, including chronic hypereosinophilia, pyogenic liver abscesses, hepatic granulomas, abdominal lymph node enlargement, pulmonary involvement, myocarditis, and thrombocytosis. Central nervous system involvement in toxocariasis is extremely rare2,3 and takes several distinct forms, including encephalopathy, meningoencephalitis, meningitis, seizures, motor dysfunction, and neuropsychiatric disturbances.3–5 Magnetic resonance imaging alterations have been described in a few patients with central nervous system toxocariasis that include vasculitic areas identified by angiography, focal lesions, and nonspecific T2-weighted areas of increased signals.2,3,6,7 The case of a male child diagnosed with congenital asplenia at 5 years of age in the context of pneumococcal septic shock is presented. Relevant facts in the patient's history include exposure to various domestic canines (the patient's father was a hunter), psychomotor development impairment with onset at 1 year of age, autistic-like behavior, and ataxia. The medical evaluation has been inconclusive. At 6 years of age, the patient was admitted to this hospital with fever and an associated leukemoid reaction. Laboratory studies showed a WBC count of 65,200/μL (65% eosinophils); normal renal and hepatic studies, and a negative C-reactive protein. Bone marrow morphology was not compatible with eosinophilic leukemia. Additional studies demonstrated a marked hypergammaglobulinemia (26.4 g/L) with markedly increased IgG (2800 mg/dL), IgE (8415 U/mL), and titers of isohemagglutinins (anti-A1, 1/8192; anti-A2, 1/4096; and anti-B, 1/256), the presence of Ascaris lumbricoides eggs in fecal samples, and a positive serologic test for Toxocara canis (passive hemagglutination test: 1/160 and ELISA: 0.662), confirmed by Western blot analysis. Ophthalmologic examination, chest radiograph, an echocardiogram, and an EEG were normal. An abdominal CT scan revealed hepatomegaly with nodules dispersed throughout the liver parenchyma; a biopsy confirmed the presence of a granulomatous hepatitis with intense eosinophilia and fibrosis consistent with parasitic infestation. Cerebral magnetic resonance imaging revealed a moderate bilateral peritrigonal hypersignal. Treatment began with mebendazole, but because of persistent eosinophilia it was changed to albendazole and prednisolone, that resulted in hematologic, radiographic and behavior/neurologic improvement. Serum values of eosinophils, immunoglobulins, and isohemagglutinins returned to normal, hepatic nodules disappeared and Toxocara antibody titers were reduced. Despite implementation of measures aimed at preventing reinfection, the patient died at 9 years of age from pneumococcal meningitis. No association has been reported between toxocariasis and asplenia. It has been suggested that bacterial or viral meningitis may be enhanced by helminthic larvae that migrate to the central nervous system.8 Additionally, it has been speculated that splenectomizated patients may be predisposed to a more rapid or severe infection by free-living parasites, as noted for Trypanosoma brucei rhodesiense.9 The diagnosis of toxocariasis requires a high level of suspicion and delayed treatment may result in pulmonary, hepatic, and neurologic lesions and sequelae. Ana Rita Araújo, JD Idalina Maciel, MD Department of Pediatrics Centro Hospitalar do Alto Minho Viana do Castelo, Portugal Licínia Lima, MD Isabel Chacim, MD Department of Pediatrics Barcelos Hospital, Portugal José Barbot, MD Department of Hematology Children's Hospital Maria Pia Porto, Portugal

Disseminierte Histoplasmose als erste Manifestation einer HIV-Infektion

A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.

Morbus Whipple: abdominale Lymphome, Fieberschübe und rezidivierende Arthralgien

A diagnostic laparotomy was performed on a 41-year old woman who, having suffered from recurrent arthralgias for several years and intermittent fever for many months, was found to have extensive enlargement of abdominal lymph-nodes, raising the suspicion of malignant lymphoma. Frozen-tissue biopsy was highly suspicious of Hodgkin's lymphoma, but light- and electron-microscopy revealed Whipple's disease, confirmed in an endoscopically obtained duodenal mucosal biopsy. The arthralgia quickly responded to antibiotic treatment. This case demonstrates the potential difficulties and errors in the diagnosis of Whipple's disease.

Ultrasound manifestations of abdominal lymphomas. An overview

Abdominal sonography is now the most frequently used screening method for the detection of abdominal lymph node enlargement. For proper classification, size, localisation and infiltration pattern must be known. The definitive determination whether lymph nodes are benign or malignant cannot be made by the size of the lesion alone. The localisation (parietal/visceral) of enlarged lymph nodes has been shown to be of significance in the staging of abdominal carcinomas. Different infiltration patterns (diffuse small nodular, focal small nodular, focal large nodular, bulky formations) show the broad spectrum of abdominal lymphomas detected by ultrasound. Knowledge of these different infiltration patterns together with clinical information often helps to discriminate between lymph node enlargement caused by inflammation, metastasis, or malignant lymphoma. The definitive diagnosis is made via laparotomy, ultrasound guided biopsy or sonographic follow-up studies.

Study of HIV-positive patients with asymptomatic retroperitoneal lymphadenopathy on antiretroviral therapy for the development of IRIS

Methods HIV-positive patients attending the Antiretroviral Therapy Centre, at CSM Medical University, Lucknow, India, who were to be initiated on ART according to clinical and immunological criteria, were screened for the presence of asymptomatic abdominal lymphadenopathy by ultrasound. Fifty patients were included in the study. They had no overt evidence of tuberculosis, malignancy, lymphoma, or atypical mycobacterium infection attributable to the enlarged abdominal lymph nodes. Ratio of males to females was 2:1, mean age of presentation was 32.5 yrs and mean CD4 count was 126/cmm. The patients were followed by repeat CD4 count (at 3 months) and clinically (monthly) for the development of IRIS and clinical progression.

ASSOCIATION BETWEEN MALIGNANCY AND SONOGRAPHIC HETEROGENEITY IN CANINE AND FELINE ABDOMINAL LYMPH NODES

Abdominal lymph node enlargement is frequently noted sonographically. Certain sonographic features can be used to suggest whether lymphadenopathy is more likely benign or malignant. Specific changes in size, shape, echogenicity, and Doppler flow patterns have an association with malignancy. In this retrospective case-control study, the association between abdominal lymph node heterogeneity and malignancy was evaluated. Twenty-three canine and 18 feline patients with ultrasonographically heterogeneous abdominal nodes were evaluated for presence of benign or malignant lymphadenopathy. Controls were animals with lymph node enlargement of uniform echogeneity. Twenty-one (91%) of heterogeneous canine lymph nodes were malignant, and there was a significant association between heterogeneity and malignancy in canine abdominal lymph nodes (P= 0.024). Seven (63%) heterogeneous feline lymph nodes were malignant, with no significant association between heterogeneity and malignancy (P = 0.537).

Supraclavicular lymph node tuberculosis presenting with immune thrombocytopenic purpura

Supraclavicular lymph node tuberculosis presenting with immune thrombocytopenic purpura

Relapsed follicular lymphoma sequentially treated with rituximab and &lt;sup&gt;90&lt;/sup&gt;Y-ibritumomab tiuxetan. Case report

Monoclonal antibodies have dramatically changed the treatment possibilities for follicular lymphoma. (90)Y-ibritumomab tiuxetan (Zevalin) is the first radioimmunotherapy agent approved for the treatment of relapsed and resistant follicular lymphoma patients. Long-term benefit was observed especially for patients achieving CR after radioimmunotherapy. A 65-year-old female patient with the second relapse of CD20 positive follicular lymphoma and multiple concomitant diseases was treated with four weekly doses of rituximab (375 mg/m(2)). (18)F-fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET-CT) demonstrated only partial response to therapy with persistent PET scan positivity in enlarged abdominal lymph nodes. Therefore, it was decided to treat her with a 1200-MBq (32-mCi) dose of (90)Y-ibritumomab tiuxetan radioimmunotherapy. No acute complications were noted afterwards. Hematological nadirs were reached 4 weeks later, with a platelet count of 24 x 10(9)/l that normalized within the next 2 weeks. The patient had neither infection nor bleeding complications. Eight weeks after radioimmunotherapy, the PET-CT scans documented only 3 lymph nodes around the abdominal aorta, maximum size 2 x 1 cm. The PET scan analysis proved no accumulation of (18)F-fluoro-deoxy-glucose in any lymph nodes or other organs and tissues. Sequential treatment with rituximab and (90)Y-ibritumomab tiuxetan may be an interesting alternative in cases of relapsed follicular or other indolent lymphomas in pretreated or older patients with other concomitant diseases.

Importance of Sonographic Detection of Enlarged Abdominal Lymph Nodes in Children

Abdominal lymph nodes are frequently visualized by sonography in the pediatric population. The term "mesenteric lymphadenitis" is frequently used in the radiologic literature to describe this finding, whereas in the pediatric literature, this term is reserved for specific inflammation of the lymph nodes. The purpose of this study was to compare by sonography the incidence of appearance of enlarged abdominal lymph nodes (EALNs) in healthy children compared with that in children with abdominal pain of various causes. In 200 patients referred for abdominal sonography for various indications, the presence of EALNs, their location, and size were registered. The patients were divided into 3 groups: those with abdominal pain due to an acute abdominal condition (group 1), those with abdominal pain without an acute abdominal condition (group 2), and asymptomatic patients (group 3). Enlarged abdominal lymph nodes greater than 5 mm were detected in 83.3% of group 1 patients, 73.8% of group 2 patients, and 64% of group 3 patients. A significant statistical difference was found between patients with abdominal pain and asymptomatic children only for lymph nodes of 10 mm and larger (P = .0117). No statistically significant difference was seen in the presence of lymph node clusters between the patients with abdominal pain and asymptomatic children. There was a tendency of increased EALN occurrence with age, peaking at 10 years, with a decrease later. Enlarged abdominal lymph nodes are frequently encountered in asymptomatic children and should not always be considered abnormal. Enlarged abdominal lymph nodes exceeding 10 mm in their shortest axis in children with abdominal pain may represent mesenteric lymphadenitis of various causes.

Unresectable gastric cancer with multiple liver metastases effectively treated with combined paclitaxel and doxifluridine chemotherapy

We report a 72-year-old man who was diagnosed by gastroscopy as having a type III poorly differentiated adenocarcinoma in the lesser curvature, with the longest diameter being 10 cm. An abdominal computed tomography (CT) scan revealed multiple liver metastases, thickening of the gastric wall, and an enlarged paraaortic lymph node. The serum carcinoembryonic antigen (CEA) level was 60 ng/ml and the carbohydrate antigen (CA) 19-9 level was 1355 U/ml. The patient received combined chemotherapy with doxifluridine (800 mg/body per day) and paclitaxel (one course comprised three weekly infusions at a dose of 70 mg/m(2) followed by 1-week rest). After the completion of three courses, the patient achieved a complete response (CR), with complete disappearance of the primary tumor, the metastatic foci in the liver, and the enlarged abdominal lymph nodes; as well, the tumor markers were normalized. Adverse effects included only mild anorexia that was limited to grade 1. He maintained a CR for 1 year and 2 months. Combination chemotherapy with paclitaxel and doxifluridine can be an effective treatment for unresectable advanced gastric carcinoma.

Ichtyose acquise révélatrice d’une tuberculose hépatique et ganglionnaire

Acquired ichthyosis is an uncommon disease usually associated with different systemic diseases. Its characteristic clinical sign is symmetrical scaling of the skin. We report a case of acquired ichthyosis revealing hepatic and lymph node tuberculosis. A 41-year-old man was admitted to our hospital with weight loss and generalized acquired ichthyosis. Ultrasonography and computer tomography showed enlargement of abdominal lymph nodes. Lymph node and liver biopsy samples were taken during exploratory laparotomy and revealed multiple lymphoepitheliomas with Langhans-type giant cells and central caseous necrosis. The skin lesions resolved progressively after 5 months of antituberculous therapy. Ichthyosis occurring in adulthood is often a sign of internal disease, especially malignant conditions. It has also been associated with autoimmune and infectious diseases, sarcoidosis and drugs. It is only rarely reported among patients with tuberculosis but it is possible that the ichthyosis in this case was due to weight loss and deterioration of the patient's general condition.

Abcès sous-cutanés à Mycobacterium avium liés à la reconstitution immunitaire chez les patients sida

Clinical presentations of opportunistic infections in AIDS patients have dramatically changed since the introduction of HAART. The immune reconstitution syndrome (IRS) is typical of this change. The authors discuss the case of an AIDS female patient presenting with subcutaneous abcesses and abdominal lymph node enlargement due to Mycobacterium avium and occurring 10 weeks after initiation of HAART. This was related to the exacerbation of immune response against the bacteria that had previously infected the patient. Many cases of IRS involving M. avium have now been described, but cutaneous localisations remain unfrequent. The treatment consists in HAART continuation associated with anti mycobacterial antibiotics and possibly anti inflammatory drugs.

Pitfalls in diagnosis of primary low-grade non-Hodgkin’s lymphomas of the spleen

17559 Background: Primary low-grade (LG) non-Hodgkin’s lymphomas (NHL) of the spleen are indolent B-cell malignancies usually involving the liver, bone marrow (BM) and the blood while disseminating. The aim of the study was to outline diagnostic problems in primary LG NHL of the spleen, and to improve recommendations regarding the differential diagnosis between these lymphoproliferative disorders and benign abdominal organ pathology (BAOP). Methods: A series of 105 patients (pts) (age range of 15–82 years) with LG splenic NHL was enrolled in our study. In all pts the diagnosis was confirmed morphologically, with immunophenotyping in selected cases. The following histological types of splenic NHL had been identified: follicular (47.6%), small lymphocytic (37.1%), marginal-zone (11.4%), and mantle cell (3.9%) lymphoma. BM involvement and leukemic conversion (LC) were revealed at diagnosis in 102 (99.0%) and 85 (83.3%) pts, respectively. Results: Leading to diagnosis symptoms resulted from splenomegaly and hematological abnormalities. Of 41 (39.0%) pts with splenic NHL, that one had been initially interpreted and treated as chronic hepatitis with hypersplenism (17/16.2%), liver cirrhosis with portal hypertension and hypersplenism (11/10.5%), gastric ulcer/chronic gastroduodenitis (4/3.8%), chronic pancreatitis (3/2.9%), collagenosis (3/2.9%), or nephritis (1/0.9%). In 12 pts with a preliminary diagnosis of chronic hepatitis, or liver cirrhosis with portal hypertension and hypersplenism splenectomy was performed at the surgical departments of district hospitals as a treatment modality of choice. In these cases the initial histological examination of spleen specimens had failed to reveal the lymphomatous involvement, that led to delay in diagnosis. In 17 (16.2%) pts with stage IV disease LG splenic NHL was confirmed occasionally during prophylaxis follow up, or examinations axed on diagnosis of internal diseases. Conclusions: Primary LG NHL of the spleen exhibit the latent onset and nonspecific clinical picture, that usually lead to delay in diagnosis due to resemblance with BAOP. Progressive splenomegaly, LC, consequent liver, abdominal and peripheral lymph node enlargement may indicate the lymphoproliferative malignancy and require BM aspiration/biopsy for diagnosis. No significant financial relationships to disclose.

Abdominal CT findings of 7 patients with pulmonary lymphgiomyomatosis

目的 探讨肺淋巴管平滑肌增生症腹部病变的CT表现.方法回顾性分析7例经病理证实的肺淋巴管平滑肌增生症,7例均作腹部CT扫描,对其腹部CT表现进行研究分析.结果7例患者中6例有腹部阳性表现:肾血管平滑肌脂肪瘤2例,其中1例合并胸导管增大、胸腔积液; 腹膜后淋巴结肿大2例,合并腹水、胸腔积液1例;肝脏血管平滑肌脂肪瘤1例;腹膜后淋巴管肌瘤合并子宫肌瘤1例. 结论肺淋巴管平滑肌增生症可并发腹部多脏器病变,CT扫描对发现和诊断其腹部病变具有重要意义。

Imaging features of multicentric Castleman's disease in HIV infection

AIM: To describe the computed tomography (CT) features of human immunodeficiency virus (HIV)-associated Castleman's disease. MATERIALS AND METHODS: Nine HIV-positive patients with biopsy-proven Castleman's disease were studied. Clinical and demographic data, CD4 count, histological diagnosis and human herpes type 8 (HHV8) serology or immunostaining results were recorded. CT images were reviewed independently by two radiologists. RESULTS: CT findings included splenomegaly ( n=7) and peripheral lymph node enlargement (axillary n=8, inguinal n=4). All nodes displayed mild to avid enhancement after intravenous administration of contrast material. Hepatomegaly was evident in seven patients. Other features included abdominal ( n=6) and mediastinal ( n=5) lymph node enlargement and pulmonary abnormalities ( n=4). Patterns of parenchymal abnormality included bronchovascular nodularity ( n=2), consolidation ( n=1) and pleural effusion ( n=2). On histological examination eight patients (spleen n=3, lymph node n=9, lung n=1 bone marrow n=1) had the plasma cell variant and one had mixed hyaline-vascular/plasma cell variant. The majority had either positive immunostaining for HHV8 or positive serology ( n=8). CONCLUSION: Common imaging features of multicentric Castleman's disease in HIV infection are hepatosplenomegaly and peripheral lymph node enlargement. Although these imaging features may suggest the diagnosis in the appropriate clinical context, they lack specificity and so biopsy is needed for diagnosis. In distinction from multicentric Castleman's disease in other populations the plasma cell variant is most commonly encountered, splenomegaly is a universal feature and there is a strong association with Kaposi's sarcoma.