Cases Of Tuberculous Lymphadenitis Research Articles

Cytomorphological Patterns in the Diagnosis of Tuberculous Lymphadenitis

The reliable diagnosis of tuberculous lymphadenitis by FNAC has important implications in a developing country like India. The aim is to study various cytomorphological patterns seen in tuberculous lymphadenitis and their correlation with AFB positivity. Fine needle aspiration cytology (FNAC) was performed on three hundred and twenty two patients with lymphadenopathy referred to the cytopathology section of pathology department, Sri Guru Ramdas Institute if Medical sciences and research Amritsar from August 2010 to July 2012. The patients with cytological diagnosis of tuberculous lymphadenitis were followed for their response to antitubercular treatment. A total of 322 FNACs were performed on patients with lymphnode lesions; out of which the most common (119) cytological diagnosis was tuberculous lymphadenitis. The most common pattern observed was (group II) presence of epitheloid granuloma with caseation necrosis which was seen in about half (50.5%) of the cases followed by smears with caseation necrosis only (group III) (27.7%) and smears with epitheloid granulomas only (group I) (21.8%).The overall AFB positivity was seen in 19.3% cases of tuberculous lymphadenitis. Maximum (30.3%) AFB positivity was seen in smears (group III) with only necrotic debris without granuloma and was least in group I (7.6%).While comparing Group I smears with that of group III using Fisher's exact test, the difference in AFB positivity between the smears was statistically significant as the two-tailed p value was 0.0496. Thus FNAC is safe, easy, quick reliable as well as conclusive for the diagnosis of tuberculous lymphadenitis when done along with Zeihl Neelsen stain for acid fast bacilli.

Linfadenitis tuberculosa en infección VIH. Hallazgos histológicos

Introducción: La coinfección de virus de inmundeficiencia humana (VIH) y tuberculosis altera la presentación histológica de la tuberculosis; esto es particularmente frecuente en la linfadenitis tuberculosa. Objetivos: Identificar las diferencias histológicas más importantes entre linfadenitis tuberculosa asociada a VIH y no asociada a VIH. Diseño: Estudio descriptivo, transversal, comparativo. Lugar: Servicio de Anatomía Patológica, Hospital Dos de Mayo. Participantes: Pacientes con linfadenitis tuberculoso asociada o no a VIH. Intervenciones: Se realizó un estudio en todos los casos diagnosticados como linfadenitis tuberculosa asociados a VIH y no asociados a VIH, durante los años 2005 y primera mitad del 2006. Principales medidas de resultados: Presentación histológica de la tuberculosis. Resultados: Se identificó 22 casos de linfadenitis tuberculosa, de los cuales 27,3% presentaba coinfección con VIH. Se identificó necrosis caseosa en 83,3% de los casos asociados a VIH y en 100% de los no asociados a VIH (p=0,00). La presencia de bacilos ácido alcohol resistentes se observó en 50% de los casos asociados a VIH y en ningún caso de los VIH negativos (p=0,01). Adicionalmente, se obtuvo un riesgo atribuible de 52,3% para la presencia de células de Langhans y el desarrollo de necrosis caseosa. Conclusiones: Se ha encontrado mayor presencia de mycobacterium en los pacientes VIH positivos y mayor presencia de necrosis caseosa en los pacientes VIH negativos.

Kikuchi-Fujimoto disease (Histiocytic necrotizing lymphadenitis): A case report

Kikuchi-Fujimoto disease (KFD) is a self-limited pathological entity that is benign in its course. The main features of this disease are tender regional cervical lymphadenopathy, usually accompanied by low-grade fever and night sweats. Less frequently patients may report weight loss, nausea, vomiting, and sore throat. Often referred to as KFD; Kikuchi-Fujimoto disease has a global prevalence with high report rates from Japan and other Asian regions. That said, it is a very uncommon case to encounter due to its rare occurrence. A viral causation is suggested keeping in view the clinical presentation, the histology and immunohistochemical pattern. The recommended procedure to diagnose this disease is an excisional biopsy of an affected lymph node. This histopathologic analysis is essential for the clinician to differentiate it from similarly presenting conditions like tuberculous lymphadenitis (scrofula), lupus (SLE) or malignant lymphoma to state a few. This is especially pertinent in regions where there is a high index of suspicion for tuberculosis given its high prevalence, like Pakistan and India for example. It is also essential to inculcate an understanding of this clinically and histopathologically challenging disease amongst physicians and pathologists alike to decrease the risk of misdiagnosis. Steps to increase awareness will also help curb the excessive costs and unnecessary interventions that go with wrong diagnoses. In young patients who present with lymph node enlargement in the posterior cervical chain; a biopsied node showing cellular and nuclear fragmentation along with features of necrosis should incite the consideration of KFD amongst other differentials. Once diagnosed; symptomatic treatment with NSAIDs, analgesics, antipyretics and in some cases corticosteroids is sufficient as the self limited disease resolves by itself within a period of 1 month in most cases. It is unlikely to stretch beyond 4 months. Patients with KFD are followed for many years nonetheless, since these patients are at a slightly increased risk of developing systemic lupus erythmatosus later in life than the general population. The case we report is that of an 18 year old female patient who presented with a month history of low grade fever, night sweats and cervical lymphadenopathy, which was minimally tender. She was initially labeled as a case of tuberculous lymphadenitis and put on antituberculous therapy. However, she did not respond and further diagnostic studies revealed the presence of KFD.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy

Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. However, the optimal approach to diagnosis, employing biopsy by either fine needle aspiration (FNA) or surgical excision, remains uncertain. To evaluate the diagnostic value of biopsy using each of the component diagnostic modalities of FNA (microscopy, cytology and culture), and compare these with excision biopsy in the diagnosis of tuberculous lymphadenitis in a predominantly migrant population in Melbourne. A retrospective examination of tuberculous lymphadenitis cases presenting to Western Health over 12 years was conducted. Using a reference method of positive culture of Mycobacterium tuberculosis, the diagnostic sensitivities of each modality employed in FNA were determined. Forty-two subjects having FNA and 30 having excision biopsy as the initial investigation were compared. Among specimens obtained by FNA, sensitivity of microscopy was 18% (95% confidence interval (CI): 5–40%) and sensitivity of cytology was 38% (95% CI: 20–59%). For specimens obtained by excision biopsies, sensitivities for microscopy and histology were 17% (95% CI: 2–32%) and 96% (95% CI: 88–100%) respectively. Sensitivity of culture performed on FNA specimens was 86% (95% CI: 65–97%). Given the relatively high sensitivity of mycobacterial cultures from FNA, this study supports its routine use as the initial investigation in most patients with suspected tuberculous lymphadenitis. Microscopy and cytology add relatively little to the clinical utility of FNA

膵頭部結核性リンパ節炎の1例

膵頭部結核性リンパ節炎の1例

Utility of concentration method by modified bleach technique for the demonstration of acid-fast bacilli in the diagnosis of tuberculous lymphadenopathy

Background:Microscopy detection of acid fast bacilli (AFB) by Ziehl–Neelsen (ZN) method has many advantages when it comes to speed and feasibility though it has a low sensitivity. If the sensitivity could be improved, it has the potential to become an even more valuable tool for detection of AFB.Objectives:To evaluate the efficacy of bleach concentration method in the cytodiagnosis of tuberculous lymphadenitis in comparison with routine Ziehl–Neelsen method and to compare the positivity in various cytomorphological categories.Materials and Methods:A total of 112 cases of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) were categorized into six cytomorphological patterns. The acid-fast bacilli positivity by routine staining was correlated with modified bleach methods of ZN staining. Sensitivity of routine ZN and modified bleach concentration was compared.Results:The classic cytomorphological pattern of tuberculosis of epithelioid granulomas, langhans giant cells and caseous necrosis was seen in 37.5% of cases. Routine ZN staining detected AFB in 12.5% of cases and the modified bleach method in 60.7%. Modified bleach method showed AFB positivity in additional 54 cases where routine AFB staining was negative. The modified bleach method showed AFB positivity in all cases where routine ZN staining was positive.Conclusion:The modified bleach method was more sensitive and safer than routine ZN staining. As the background was clear, the bacilli were easily visible and the screening time was shorter.

A Comparison Of Three-Drug Anti-Tuberculous Treatment And Directly Observed Treatment Short Course In The Treatment Of Tuberculous Lymphadenitis

Setting: DOTS program implemented in the management of extra pulmonary T.B. cases under RNTCP.Objective: To study the efficacy of DOTS vs. conventional three-drug antituberculous treatment in the outpatient setting and to compare patient compliance and recurrence rates.Methods: Sputum-negative patients with tuberculous lymphadenitis cases identified at OPD level in Goa Medical College (GMC). Cases randomly allocated to three-drug and DOTS regimens. Three-drug regimen cases followed up on monthly basis at GMC OPD with monthly drug collection. DOTS cases assigned to nearby health centre for drug collection and supervised therapy and followed up at two and six months of therapy at GMC OPD. Cases assessed for decrease in lymph node size and total clearance.Results: A total of 50 outpatients were enlisted in the study and randomly assigned to DOTS and three-drug groups after clinical workup and a pretreatment interview. At two month follow-up, 100% DOTS cases showed decrease in lymph node size as compared to 0% of three-drug cases. At six months follow-up, both groups showed total lymph node clearance in 100% cases. DOTS group had three defaulters (12.5%) due to migration, and could not be followed up. No recurrences or treatment failures were observed.Conclusions: DOTS therapy is shown to be equally efficacious to the conventional three-drug regimen in management of tuberculous lymphadenitis, with early reduction in lymph node size. Default rate is still high, despite availability of drugs, due to migrant population. INTRODUCTION One Fifth of the global T.B. incidence is in India, with 1.8 million new cases every year, 0.8 million of these being infective and smear positive cases. The disease incidence peaks in people belonging to the most economically productive age group of 15-60 years. Peripheral lymph node involvement is the commonest form of extra pulmonary mycobacterial tuberculosis and the cervical region is the most commonly affected site. Tuberculous cervical lymphadenitis tends to occur more often in females and presents in young adults. According to Raviglione et al, HIV is the single most important risk factor for the progression of dormant tuberculosis into clinical disease, the virus compromising the immune response. The Revised National Tuberculosis Control program was introduced in India in 1993, and expanded to cover the entire population by June 2005. The RNTCP applied the WHO recommended DOTS strategy (Directly Observed Treatment Short Course), thus shifting the responsibility for cure from the patient to the health system. A study was carried out in the Goa Medical College (GMC) – Bambolim, Goa, comparing the standard Three-drug antituberculous treatment regimen to DOTS in the management of Tuberculous Lymphadenitis on an outpatient basis. MATERIAL AND METHODS STUDY POPULATION The study was conducted in the Out Patient Department of Surgery, Goa Medical College from August 2004 – August 2006. Study subjects had to fulfill the following: PRETREATMENT INVESTIGATIONS A) CLINICAL WORKUP B) PRETREATMENT INTERVIEW: AS PER CLINICAL PROFORMA Treatment regimens: A Comparison Of Three-Drug Anti-Tuberculous Treatment And Directly Observed Treatment Short Course In The Treatment Of Tuberculous Lymphadenitis 2 of 4 Patients were allocated to two groups by random sampling numbers. Group A: Daily self administered AKT3 2 MONTHS 4 MONTHS Group B: Category III DOTS-thrice weekly administration 2 MONTHS 4 MONTHS Patients weighing > 60 kg received additional Rifampicin 150 mg. Patients weighing less than 30 kg received drugs as per body weight. LOGISTICS Patients with self administered regimen were asked to visit the GMC OPD once a month to collect the drugs to be self administered at home. They also had to follow up at the end of two months and at completion of treatment. Patients started on Category III DOTS were registered under the same and asked to follow up at the closest health centre for drug collection. For the first two months (24 doses), the patient visited the health centre thrice weekly and took antituberculous treatment under direct supervision of the DOTS provider. For the next four months (54 doses), the patient visited the DOTS centre once weekly to collect the blister pack for the weekly treatment. One separate box containing blister packed rugs was earmarked for the patient in the health centre from Day 1 of treatment to avoid treatment interruption due to drug shortage. The patient followed up in GMC OPD at two months and six months for assessment.

Fine needle aspiration cytology in childhood TB lymphadenitis

To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Tuberculous cervical lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma

We report two unusual cases of tuberculous lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma (PTC). Pre-operative ultrasonography of the cervical nodes suggested a metastasis with cystic necrosis and calcification in PTC patients, but permanent pathology revealed tuberculosis lymphadenitis after neck dissection. In cases suspicious for metastatic cervical nodes in patients with PTC, fine-needle aspiration cytology may be indicated for the differential diagnosis of tuberculosis lymphadenitis, especially in those who have experienced tuberculosis in the past.

Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings

Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation. The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases. Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma. Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma. Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.

PCR detection of Mycobacterium tuberculosis in necrotising non-granulomatous lymphadenitis using formalin-fixed paraffin-embedded tissue: a study in Thai patients

Background:Necrotising non-granulomatous lymphadenitis can be observed in several conditions, most notably infection (including tuberculosis, yersiniosis and nocardiasis), Kikuchi–Fujimoto disease and systemic lupus erythematosus.Aims:To evaluate the role of PCR in the...

Role of Modified Bleach Method in Staining of Acid-Fast Bacilli in Lymph Node Aspirates

To correlate acid-fast bacilli (AFB) positivity with cytomorphologic patterns of tuberculous lymphadenitis and evaluate bleach concentration method in diagnosing lymph node tuberculosis compared to Ziehl-Neelsen (ZN) method.One hundred cases of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) were analyzed and classified into 6 cytomorphologic patterns and correlated with bacillary load using routine and modified bleach methods of ZN staining. Smears were graded for AFB positivity. Sensitivity of routine ZN and modified bleach concentration was compared.The classic cytomorphologic pattern of tuberculosis showing epithelioid granulomas, Langerhans giant cells and caseous necrosis was seen in 23% of cases. Routine ZN staining detected AFB in 27% of cases and the modified bleach method in 72%. In 58 cases the modified bleach method had a higher grade of AFB positivity than the routine method. The modified bleach method did not miss any AFB positivity detected on routine ZN staining.The modified bleach method demonstrated AFB positivity in 72% of cases. AFB positivity grade was much higher than with routine ZN staining, making bacilli easily visible, with shorter screening time. The modified bleach method is inexpensive, easily performed and more sensitive and safe than routine ZN staining.

New Cytologic Clues in Localized Leishmania Lymphadenitis

To describe new cytologic clues to diagnose localized leishmania lymphadenitis (LLL).The study examined cytologic smears of 170 cases of LLL referred to our department from November 1989 to October 2004. A total of 120 cases were confirmed by detecting Leishman-Donovan (LD) bodies in at least 1 of the cytologic smears and 50 cases, which were histologically confirmed. For comparison we studied cytologic smears of 20 cases of tuberculous lymphadenitis, 20 cases of toxoplasma lymphadenitis and 20 cases of granulomatous lymphadenitis of unspecified causes.Cases were divided into 4 major groups. Cytologic findings in these groups were studied to find highly suggestive clues. Cytologic findings present in most of these groups, but absent or very rare in other granulomatous lymphadenitis, were LD kinetoplasts, plasma cells with different shapes of inclusions and lymphogranular bodies. Rare findings not reported previously were: intraneutrophilic LD bodies, hematoxylin body-like inclusions, fibroblasts, cytoplasmic blebbing and floating parasitophorous vacuoles.Despite previous reports emphasizing detecting LD bodies in diagnosing LLL, we present cytologic clues highly suggestive of this self-limited disease when LD bodies cannot be detected or are very few on the smears.

Tuberculous lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis

The aim of this study was to review the clinical features of tuberculous (TB) lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine cases of TB lymphadenitis were diagnosed among 910 patients over a period of 10 years. There were five men and four women with a mean age of 51 +/- 15.5 years. The TB lymphadenitis involved the cervical lymph nodes in six patients, supraclavicular lymph nodes in two patients and mediastinal lymph nodes in one patient. Six patients presented with clinically enlarged lymph nodes of whom four also had fever. Three other patients were incidentally found to have enlarged lymph nodes on routine chest X-ray or ultrasound examination of the neck. Diagnosis of TB lymphadenitis was made by demonstrating caseating granulomata with or without positive acid-fast bacilli on excisional lymph node biopsy. All patients were cured with standard anti-tuberculosis drugs for 12 months. No recurrence of the TB lymphadenitis was observed after a mean follow-up of 59 +/- 30 months. We conclude that TB lymphadenitis is not uncommon among patients on CAPD. A high index of suspicion is needed for early diagnosis of this condition. Prompt initiation of anti-tuberculosis treatment is associated with good prognosis.

A Clinical Scoring System as Useful as FNAC in the Diagnosis of Tuberculous Lymphadenitis in HIV Positive Patients

Among HIV positive patients, Fine needle aspiration cytology (FNAC) or biopsy for diagnosis of tuberculous lymphadenopathy is often avoided due to an unspoken stigma. Earlier, we had developed a clinical scoring scale for the diagnosis of tuberculous lymphadenitis (TBLN), which had 88% sensitivity and detected no false positives. In the present study, we attempted to develop similar scale that could assist in diagnosing TBLN in AIDS. All 42 HIV positive patients of adenitis attending Ramdeo Hospital and Research Centre, Jodhpur between August 2001 and December 2004 were studied. History of past tuberculosis, age, history of rapid weight loss, site, size, consistency, and the presence of matting and sinus formation of enlarged lymph nodes, result of tuberculin test, sputum smear and findings in chest radiograph were compared between patients diagnosed as TBLN and those showing non-tuberculous lymphadenitis (Non-TBLN) on cytopathological examination of material obtained by fine needle aspiration. Based on the results, clinical scores from zero to two were assigned to different clinical features. The total clinical score was then calculated for each patient. A total clinical score of five or more included all TBLN cases and only 10.5% false positives. This scoring system can be used in remote peripheral areas, which do not have the facility for biopsy or FNAC.

Nucleic Acid Amplification of Mycobacterium tuberculosis Complex DNA from Archival Fine Needle Aspiration Smear Scrapings vs. Fresh Fine Needle Aspirates of Tuberculous Lymphadenitis

To assess the efficacy of the nucleic acid amplification (NAA) technique for Mycobacterium tuberculosis (MTB) complex from archival fine needle aspirate (FNA) smear scrapings of confirmed cases of extrapulmonary tuberculosis (EPTB) for a retrospective diagnosis of EPTB as compared to NAA from fresh FNA material from the same cases.Smear scrapings from 51 cases; 33 cases of tuberculous lymphadenitis (from patients who had undergone NAA 1 year before for MTB from fresh FNA material); 13 negative controls from nontuberculous, archival FNA smears; and 5 known acid-fast bacilli (AFB)-positive sputum smears, were subjected to NAA using the IS6110 primer sequence of M tuberculosis. Ziehl-Neelsen staining was done in all the smears.Of the 33 cases of tuberculous lymphadenitis, 15 (45.4%) were AFB positive and 18 (64.5%) AFB negative. MTB NAA was positive in 73.3% (11 of 15 AFB-positive cases) in the freshly aspirated material and was observed in 60% (9 of 15 AFB-positive cases) when done on DNA extracted from the archival smear scrapings of the same cases. Similarly, in the 18 AFB-negative cases, MTB NAA positivity was 72.2% (13 of 18) on fresh material and 44.4% (8 of 18) on archival smear scrapings from the same AFB-negative cases. Overall NAA positivity was 51.5% for archival smear scrapings as compared to 71% for fresh FNA of the same cases.Low NAA sensitivity of MTB DNA in archival material of known tuberculous cases limits the routine use of NAA based retrospective molecular diagnosis of MTB complex.

A case of tuberculous lymphadenitis found as an abdominal mass penetrating the duodenum

A case of tuberculous lymphadenitis found as an abdominal mass penetrating the duodenum

Role of mammography in diagnosis of axillary abnormalities in women with normal breast examination.

The mammograms of 43 patients presenting with palpable unilateral masses in the axilla and normal breasts on physical examination were retrospectively reviewed to determine the cause and imaging characteristics of axillary abnormalities, and the usefulness of mammography in detecting occult breast carcinoma. Cytological or histological confirmation was obtained in all patients. Forty of 43 patients had axillary lymphadenopathy while three had lipoma, fibroadenoma and haematoma, respectively. Causes of malignant lymphadenopathy (n = 22) were metastatic diseases from non-mammary primary malignancy (n = 8), occult ipsilateral breast carcinoma (n = 5), and previous contralateral breast carcinoma (n = 9). Causes of benign lymphadenopathy (n = 18) were reactive nodal hyperplasia (n = 6), collagen vascular diseases (n = 2), and acute bacterial (n = 2) and tuberculous (n = 8) lymphadenitis. Nodal size was not significantly different between benign and malignant lymph nodes. Benign and malignant nodal margins were variable. Intranodal microcalcifications were found in two cases of breast carcinoma metastasis. Intranodal macrocalcifications were found in three cases of tuberculous lymphadenitis. Occult primary breast carcinoma was detected on mammograms in four of five patients with axillary lymphadenopathy due to ipsilateral breast carcinoma. Mammographical features of benign and malignant lymphadenopathy may be indistinguishable, but presence of intranodal calcifications is helpful. Mammography is also valuable in depicting occult primary breast carcinoma.

Non malignant peripheral lymphadenopathy in Nigerians.

Persistent peripheral lymphadenopathy (PL) not associated with malignancy or a focal lesion can pose a diagnostic and therapeutic problem. This study reports the pathological findings in the lymph nodes of 225 patients who presented with PL at the University Hospital, Ile-Ife, Nigeria within a period of ten years. Majority of the patients were male, with a male: female ratio of 1.5:1. Patients below the age of 41 accounted for 70.6% of the cases. Children aged 0-15 years accounted for 27.1% of total number of cases. The most common histopathologic diagnosis was chronic granulomatous lymphadenitis (49.3%) with tuberculosis accounting for almost all the cases. Thirty six (32.7%) cases of tuberculous lymphadenitis occurred in children. Other pathological lesions were: chronic non specific lymphadenitis (35.6%) reactive lymphadenopathies (13.3%) and acute lymphadenopathy (1.8%). Toxoplasmosis was the most common cause of reactive lymphadenopathy. Tuberculosis should be suspected and ruled out in patients who present with PL, particularly in rural areas with no access to histopathology services.