Cause Of Lymph Node Enlargement Research Articles

Diagnostic value of multimodal ultrasonographic techniques in evaluation of lymphadenopathy in the neck

Background Recent ultrasound (US) imaging techniques, including high-resolution gray-scale, color, power, pulsed Doppler, and strain sono-elastography, are recent modes for US evaluation. Aim This prospective study aimed to review the value of the recent US modes in differentiating causes of lymph node enlargement in benign and malignant conditions. Patients and methods The study included 30 patients with enlarged cervical lymph nodes throughout the period from August 2022 to September 2023. Multimodal US techniques were used for all cases. Results In benign lesions, the lymph node size was taken. The shape index range was 0.31–0.66 with a mean=0.48 ± 0.9. Using Doppler US, they showed elevated hilar flow without peripheral vascularity. Using elastography, these nodes gave soft strain values range=0.60–1.00 with a mean=0.80 ± 0.2. In malignant lesions, the lymph node shape index range=0.55–0.81 with a mean=0.68 ± 0.4. Using Doppler, the nodes showed increased vascularity in most patients and avascular nodes in others. Using elastography, these nodes gave hard strain values with a range=1.70–11.75 and a mean=4.70 ± 5.0. Conclusion The use of multimodal US imaging (gray scale, color Doppler, pulsed Doppler, power Doppler, and elastography), in addition to the clinical history of the disease, differentiates benign from malignant causes of lymph nodes enlargement and are useful in selecting the lymph node for fine-needle aspiration cytology or biopsy.

Cytomorphological Pattern of Lymph Node Swelling in Tertiary Care Unit

Background: Tubercular lymphadenitis is one of the most common causes of lymph node enlargement in developing countries. Fine needle aspiration cytology is a simple cost-effective, Rapid and reliable technique and first line investigation for diagnosis of superficial and deep lesion. Aim and objective: of our study was to evaluate the common cytomorphological pattern of lymph node swelling in pathology department of BMSI, Jinnah post graduate medical centre Karachi. Materials and methods: Cross sectional study was conducted at BMSI, Jinnah Post Graduate Institute Karachi. During the period of January to December, 2021, total 350 lymph node swelling were aspirated smear and cell block prepared Aspiration done with 22 to 24 needle gauge syringe.one slide is stained with the diff quick stain and evaluated for diagnostic material inadequate materials were re-aspirated at the time of FNA, three slides were stained with heamotoxylin and eosin stain. Cell block prepared. Results: Total 350 lymph node swelling were aspirated during study time out of which 203(58%) cases diagnosed as chronic granulomatous inflammation, 43(12.3%) cases diagnosed as necrotizing inflammation. 37(10.6%) case diagnosed as abscess and 22(6.3%) cases as reactive hyperplasia, 39(11.1%) cases as metastatic lesions. Conclusion: Chronic granulomatous inflammation is a heavy burden of lymphadenopathy in our setup followed by necrotizing inflammation Keywords: BMSI FNA granulomatous inflammation

Management of Infectious Lymphadenitis in Children.

Lymphadenopathy is an irregularity in the size and texture of the lymph nodes, which is quite common in childhood. When the enlargement of lymph nodes is caused by inflammatory and infectious processes, it is called lymphadenitis. The main objective of this manuscript is to summarize the common infectious etiologies and presentations of lymphadenitis in children providing a management guide for clinical practice. PubMed was used to search for all of the studies published up to April 2021 using keywords such as “lymphadenitis” and “children”. Literature analysis showed that the differential diagnosis for lymphadenitis in pediatrics is broad. Although lymph node enlargement in children is usually benign and self-limited, it is important to exclude malignant etiology. In most cases, history and physical examination allow to identify the correct diagnosis and start a proper treatment with a prompt resolution of the lymphadenopathy. However, particularly in the case of persistent lymphadenitis, determining the cause of lymph node enlargement may be difficult, and the exact etiology may not be identified despite extensive investigations. Further studies should develop and validate an algorithm to assist pediatricians in the diagnosis and timely treatment of lymphadenitis, suggesting situations in which a watchful waiting may be considered a safe approach, those in which empiric antibiotic therapy should be administered, and those requiring a timely diagnostic work-up.

FNAC SPECTRUM OF LYMPHADENOPATHY IN A TERTIARY CARE HOSPITAL

Background – The aim of this study was to identify the pattern of pathologies on FNA of supercial lymph nodes in a tertiary hospital over a period of one year. Methods – The data pertaining to our reports given to the patients who underwent FNAC evaluation of supercial lymph nodes was analysed to determine age distribution of patients, group of lymph nodes involved and distribution of pathologies diagnosed . Results – Majority of patients were adults. Cervical group of lymph nodes were most commonly involved. Granulomatous lymphadenitis was the predominant diagnosis in our series 39%. Conclusion – Fine needle aspiration evaluation is a quick, easy, relatively non traumatic and in expert hands, a reliable method of diagnosing the pathology of underlying enlarged supercial lymph nodes. Granulomatous lymphadenitis was the most common causes of lymph node enlargement in our series.

Cytomorphology of lymphadenopathy with a report on patterns of tuberculous lymphadenitis in a resource-limited setting

Context: Lymphadenopathy is one of most common clinical presentations, for which fine-needle aspiration (FNA) is indicated as the first-line investigation since it is a reliable, rapid, simple, cost-effective procedure done in the outpatient department. Aims: The study was performed to assess the various cytomorphological patterns of the lymph node aspirates in patients presenting with peripheral lymphadenopathy. Subjects and Methods: The prospective study included 81 patients with complaints of peripheral lymphadenopathy on whom FNA was done in the Department of Pathology at our hospital. The smears were analyzed and categorized according to their cytomorphological patterns. Results: Of 81 patients, 30 were male and 51 were female. The male:female ratio was 1:1.7. The age of the patients ranged from 3 to 83 years, with a mean age of 35.2 years. Reactive lymphadenitis (48.15%) was the most common lesion followed by tuberculous lymphadenitis (33.33%). Acid–fast bacilli (AFB) positivity was noted in 13 out of 27 cases (48.15%) with tuberculous lymphadenitis. The cases of tuberculous lymphadenitis were further divided into three groups based on cytomorphology, of which Group 2 lesions (epithelioid granulomas with necrosis) were most common and Group 1 lesions (epithelioid granulomas without necrosis) were least reported. Group 3 lesions (necrosis without epithelioid granulomas) were all positive for AFB. There were nine cases (11.11%) of acute suppurative lymphadenitis and six cases (7.41%) of metastatic squamous cell carcinoma to the lymph nodes. Conclusions: FNA is an ideal tool which can be used as a basic investigation for the evaluation of lymphadenopathy. Reactive lymphadenitis followed by tuberculosis was the major cause of lymph node enlargement in our setup. Epithelioid granulomas with or without necrosis and/or AFB positivity on the cytological smears and with associated clinical symptoms should be considered as tuberculosis in our clinical setup unless proven otherwise.

Surgical peripheral lymph node biopsies in Makurdi, Nigeria.

This study aims at determining the diagnostic value of peripheral lymph node biopsy and common causes of lymph node enlargement from biopsies obtained from patients with lymph-node enlargement at different sites in a teaching hospital in north central Nigeria town of Makurdi, Benue State. This is a retrospective study of surgical peripheral lymph node biopsies received in the department of Anatomic Pathology, Benue State University Teaching Hospital, Makurdi, Nigeria from February, 2012 to September, 2019. Total number of lymph node biopsies during the period was 47 representing 1.0% of surgical pathology specimens submitted to the department; 25 cases were females and 22 were males. Metastatic nodal involvement (57%), lymphoma (23%) and tuberculosis lymphadenitis (11%) were the most common causes of lymph node enlargement. All the studied nodes were localized. The most common sites of lymphadenopathy were axillary (21%), cervical (16%) and Inguinal (6%). While axillary lymph node enlargements were mostly associated with tumor metastasis, cervical and inguinal node enlargements were mostly associated with tuberculosis and lymphoma, respectively. Surgical excision of nodal enlargement for histological examination represents a simple, good diagnostic yield with lack of significant morbidity or mortality.

Spectrum of histopathological diagnosis of lymph node biopsies and utility of immunohistochemistry in diagnosis of lymphoma: A 5 year retrospective study from a tertiary care Centre in South India

Spectrum of histopathological diagnosis of lymph node biopsies and utility of immunohistochemistry in diagnosis of lymphoma: A 5 year retrospective study from a tertiary care Centre in South India - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.083, Indian Journal of

Giant cell tumor tendon sheath at inguinal region masquerading as enlarged lymph node

Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor and is the second most common tumor of the hand after ganglion cysts. It is a slow-growing benign lesion of the soft tissues. The etiology of GCTTS is not clear. Although GCTTS most commonly presents in a digit of the hand, it may also present in the palm, wrist, foot, knee, ankle, elbow, or hip. Here, we present a rare case of GCTTS originating at the inguinal region, which has not been previously reported. A 52-year-old male presented with a 2 cm × 1 cm swelling at the right inguinal region. The clinical impression was inguinal lymph node enlargement. Ultrasonography (USG) showed the presence of large inguinal lymph node. Fine-needle aspiration cytology (FNAC) showed the features suggestive of giant cell lesion, possibly GCTTS. Repeat ultrasound revealed a large oblong-shaped hypoechoic lesion with mild internal vascularity in the right inguinal region above the external oblique aponeurosis, suggestive of aponeurotic giant cell tumor. Histopathology was confirmatory. Here, we report this case to highlight the role of FNAC in diagnosing GCTTS at a rare site, i.e., inguinal region. Due to its location at inguinal region, along with clinical suspicion of tubercular lymphadenitis and USG findings showing large inguinal lymph node in the right inguinal area, it needs to be differentiated from other causes of lymph node enlargement. It would be prudent to state that FNAC along with radiology can help reach the final diagnosis.

Evaluation of Fine Needle Aspiration Cytology of Cervical Lymphadenopathies at Tertiary Care Center

Background: Lymphadenopathies in the neck region is the most frequently sent for the cytology evaluation from the clinicians, involvement in regional and systemic diseases and their easy accessibility make the FNAC as a primary workup. Inflammatory and immune reactions are the most frequent causes of lymph node enlargement and are self limiting in majority of cases. Tuberculosis can also be diagnosed by cytology of affected lymph nodes. With the advent of FNAC, most of the inflammatory, reactive and neoplastic conditions can be diagnosed without biopsy. It has the advantage that it can be done safely, rapidly and cheaply with minimal trauma at an outpatient setup or at the bedside. Methods: This study was conducted at cytology section of pathology department of our institute. Patients from ENT, Surgery, Medicine, Pulmonary medicine departments were referred for FNAC. Written informed consent was obtained from all patients. It included patients with lymphadenopathies in cervical region. FNAC was conducted with the help of a 24 guage disposable needle attached to a 10cc syringe. Smears were fixed in methanol and stained with Haematoxylin and Eosin as well as Papanicolaou stains. MGG stain was done on air dried smears. The results expressed as percentage were tabulated. Result: Maximum numbers of patients were diagnosed with Reactive Lymphadenopathy 67/266 (25%), followed by Chronic Granulomatous Inflammation 59/266 (22 %), Metastatic 52/266(20%), Acute Suppurative 37/266 (14%), Tuberculous 27/266 (10%), Non Specific 14/266 (5 %), Lymphoma (primary) 8/266 (3%) and miscellaneous 2/266 (1%) consists Sinus Histiocytosis & Kawashaki disease. Histopathological correlation was available in 25/266 cases. Conclusion: FNAC is a safe, simple & inexpensive primary immediate diagnostic procedure and workup for lymph node enlargements, especially in cervical lymphadenopathies where biopsies are not done routinely. DOI: 10.21276/APALM.1527

Histopathological of lymph node biopsies in Lagos, South West Nigeria

Lymph nodes are discrete ovoid lymphoid structures that are widely distributed throughout the body. Lymph node enlargement is a common clinical problem, and biopsies are usually undertaken to determine the cause of nodal enlargement. The aim of this study is to elucidate the pattern of lymph node biopsies seen in Lagos State University Teaching Hospital (LASUTH), Ikeja. This is an 8 year retrospective study of all lymph node biopsies sent to our laboratory between 1st January 2008 and 31st December 2015. All slides were retrieved and reviewed. The demographic data regarding age, sex, provisional diagnosis and site of biopsy were obtained from request forms. The data were analysed using the Statistical Package for Social Science version 21. There were 123 lymph node biopsies seen during the study period with age range of 1- 78 years and male to female ratio of 1.2:1. The first decade recorded the highest samples (17.9%), followed by the 4th decade (17.1%). The cervical region is the most common site biopsied, (41.5%), followed by axillary lymph node (17.1%). Metastasis was the most common diagnosis (26.0%), then tuberculous lymph nodes (22.8%). Metastasis was commonest in females and in the 5th decade while tuberculosis was most common in males and in the 4th decade. Metastasis is the most common cause of lymph node enlargement and seen predominantly in females in the fifth decade of life. Tuberculosis is commonest in fourth decade while lymphoma showed bimodal frequency in first and sixth decade.Keywords: nodal enlargement, metastasis, tuberculosis, lymphoma

Spectrum of pathologies on FNAC evaluation of peripheral lymph nodes at a tertiary care center in hyderabad: a retrospective study

Background: The aim of the study was to study the pattern of pathologies identified on FNA of superficial lymph nodes in a tertiary hospital in Hyderabad during the period January 2014 to August 2016, as well as to identify the profile of patients undergoing the procedure at our Hospital. Methods: The data pertaining to the details of the patients who underwent FNA evaluation of superficial lymph nodes from the period January 2014 to 31 August 2016 at a tertiary hospital located in Hyderabad, Telangana, was analysed to determine the age and sex distribution of the patients and the distribution of pathologies diagnosed on FNA evaluation of the lymph nodes. Results: The female gender was predominant (61%; 156 out of 253 patients) among the patients who underwent FNA evaluation of lymph nodes. A majority of the patients were in the age group of 20 to 50 years. Reactive lymph node hyperplasia was the predominant diagnosis in our series (49.8 %; 126 cases out of 253 FNA evaluations). Granulomatous lymphadenitis was the second most common diagnosis (37.15%; 94 out of 253 FNA evaluations). Conclusions: Fine Needle Aspiration evaluation is a quick, easy, relatively non - traumatic, and, in expert hands, a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes. Reactive lymph node hyperplasia and granulomatous lymphadenitis were the two most common causes of lymph node enlargement in our series.

Exceptional Cause of Massive Lymph Node Enlargement: Primary Localized Amyloidosis

Amyloidosis is very rarely the cause of lymph node enlargement. In the localized form of the disease, amyloidosis commonly attains the bladder, the lung and the skin. Lymph node amyloid deposition is very unusual in the localized form of the disease. In particular, cervical and mediastinal sites are uncommon. We report an exceptional case of primary localized AL amyloidosis presenting as generalized lymph node enlargement. Our patient was initially treated by colchicine but in front of disease progression, a treatment with prednisone and melphalan was necessary for stabilization. Clinician should consider primary amyloidosis in the check-list of etiologies causing lymph node enlargement.

Pattern of lymph node pathology in western Saudi Arabia.

This study aimed to characterize the histopathological pattern of lymph node pathology among Saudi patients and to highlight the age and gender variations of these lesions as base line data. We retrospectively analyzed the data from lymph node biopsy specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Of the 289 lymph node biopsy specimens received, 154 (53.3%) were from males and 135 (46.7%) from females giving a male: female ratio of 1.14:1. Age of the patients ranged from 2.5 to 96 years with a mean age 33.9 years. The commonest lymph node group affected was the cervical (30.4%) followed by axillary (9.7%) and inguinal (8.7%). Malignant lymphoma [71 Hodgkin's disease (HD), 57 non Hodgkin's lymphoma (NHL)] 128 (44.3%), reactive hyperplasia 68 (23.5%), and tuberculosis 41 (14.2%) were the common causes of lymph node enlargement. While HD, reactive hyperplasia and tuberculosis were commonest in young adult patients (10-29 years old) and rare above the age of 50 years; NHL was the predominant cause of lymph node enlargement above 50 years. Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.3%) followed by non-specific reactive hyperplasia (23.5%) and tuberculous lymphadenitis (14.2%).

Cytomorphological patterns of tubercular lymphadenitis revisited.

Background:Tubercular lymphadenitis is one of the most common causes of lymph node enlargement in developing countries. Fine needle aspiration cytology (FNAC) plays an important role in diagnosing Tubercular lymphadenitis and prevents unnecessary surgical intervention.Aim:To study the cytomorphological patterns of tubercular lymphadenitis in our study population and correlate the bacillary load by acid fast staining with cytomorphological patterns.Materials and Methods:A total of 150 cases of cytological proven granulomatous lymphadenitis and cases without granuloma, but positive acid fast bacilli (AFB) on Ziehl Neelson (ZN) stain were included in our study. Cytomorphological patterns were categorized into four patterns. Pattern A – Epithelioid granuloma without necrosis, Pattern B – Epithelioid granuloma with necrosis, Pattern C – Necrosis without epithelioid granuloma with neutrophilic infiltrate. Pattern D – with numerous macrophages. Chi-square test was done to correlate cytomorphological pattern and bacillary load. A 2 × 2 analysis was done to test the degree of one hypothesis. A P < 0.05 was considered as significant.Results:Patterns and the number of cases observed are as follows: Pattern A – 29 cases, Pattern B – 84 cases, Pattern C – 34 cases. A distinct D Pattern with abundant foamy macrophages was seen in three immunodeficient patients. Positive ZN staining was seen in 81/150 54% of cases. The cytological patterns of AFB positive cases Pattern A: 6/29 (21%), Pattern B: 46/84 (55%), Pattern C: 25/34 (73.5%), Pattern D: 4/4 (100%).Conclusion:FNAC is useful in diagnosing tubercular lymphadenitis. Maximum bacillary load was seen in Pattern C. A distinct D Pattern was seen in immunodeficient patients.

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: A three year study at tertiary center

Background: Lymphadenopathy is a common presenting symptom in various diseases. Objective: The present study was undertaken to evaluate the usefulness of fine-needle aspiration cytology (FNAC) as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies. Materials and Methods: The present study was conducted in the department of pathology, Shri M.P. Shah Medical College, Jamnagar from June 2008 to July 2011. FNAC of the enlarged lymph nodes was performed with informed consent of the patient. Totally 1022 patients of lymphadenopathy who underwent FNAC were divided into three groups: Group I (0-20 years), Group II (21-50 years) and Group III (>51 years). Results: Maximum number of patients with lymphadenopathy was in Group II: 502 (49.11%), followed by Group I: 378 (36.98%) and in Group III there were 142 (13.90%) cases. Most common causes of lymphadenopathy in different groups were found to be: In Group I: Reactive hyperplasia 198 cases (52.38%), Group II: Tubercular lymphadenitis 232 cases (46.21%) and Group III: Metastatic carcinoma 80 cases (56.33%). Conclusion: It was concluded that different etiological factors play a role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy.

Utility of Fine Needle Aspiration Cytology of Lymph nodes

Background: The incidence of lymphadenopathy appears to be increasing, especially among young adults all over the world. Their frequent involvement in regional and systemic diseases and their easy accessibility make the cytomorphological study of lymph nodes a permanent activity of pathologists. Inflammatory and immune reactions are the most frequent causes of lymph node enlargement and are self limiting in majority of cases. Lymphoid tissue undergoes reactive changes to a wide variety of antigenic stimuli. Tuberculosis, which is common in India, can also be diagnosed by cytology of affected lymph nodes. Lymph nodes are also affected as a result of primary neoplasm of the node itself and from metastasis of malignant neoplasm from regional and distant organs. With the advent of FNAC, most of the inflammatory, reactive and neoplastic conditions can be diagnosed without biopsy. It has the advantage that it can be done safely, rapidly and cheaply with minimal trauma at an outpatient setup or at the bedside. Material and Methods: This study was conducted at our institute which caters to patients belonging mostly to the lower socioeconomic group, after IEC (Institute Ethics Committee) approval. Written informed consent was obtained from all patients. It included 355 patients with lymphadenopathies at various sites. Acellular aspirates were excluded from the study. FNAC was conducted with the help of a 22 guage disposable needle attached to a 20cc syringe. Smears were fixed in 95% ethyl alcohol and stained with Haematoxylin and Eosin as well as Papanicolaou stains. Leishman stain was done on air dried smears. The cases suspected as Lymphoma were confirmed by biopsy or referred for Immunohistochemistry. The results expressed as percentage were tabulated. Results: Maximum numbers of patients were diagnosed with Reactive Lymphadenopathy 122/355 (34.36%), followed by Chronic Granulomatous Inflammation 72/355(20.28 %),Metastatic Lymphadenopathy 65/355(18.30 %), Acute Suppurative Lymphadenopathy 40/355 (11.26%), Tuberculous Lymphadenopathy 28/355 (7.88%), Primary neoplasm 14/355 (3.94%), Non Specific Lymphadenopathy 10/355 (2.81 %) and Sinus Histiocytosis 4/355 (1.12%). Histopathological correlation was available only in 36/355 cases. The correlation was correct in 32/36 cases (88.88%), making the sensitivity of the procedure 72.2%. In case of malignancies the histopathological correlation was 100%. Conclusion: FNAC is a safe, simple & inexpensive definite diagnostic procedure to render a prompt diagnosis for lymph node enlargements, especially in lymph node aspirates where biopsies are not done routinely.

Evaluation of etiology of lymphadenopathy in different age groups using Fine Needle Aspiration Cytology: A retrospective study

Background: Lymphadenopathy is a common presenting symptom in various diseases. Lymph nodes react to various stimuli and undergo changes leading on to vast array of neoplastic or non-neoplastic proliferations. FNAC is a simple, quick and inexpensive method that is used to sample superficial masses and is now considered a valuable diagnostic aid. Objective: The present study was undertaken to evaluate the usefulness of FNAC as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies.Settings and design: Retrospective study conducted in the Department of Pathology, Subharti Medical College, Meerut from July 2006 to June 2009 (3years).Material and Methods: Total 1350 patients of lymphadenopathy who underwent FNAC were divided into 3 groups: Group I including pediatric patients (i.e. 0-15 years), Group II including adolescent and middle aged patients (i.e. 16-45 years) and Group III with elderly patients (i.e. >45 years).Observation: Maximum number of patients with lymphadenopathy was in Group II with 640 patients (47.4%), followed by Group I: 498 patients (36.89%) and Group III: 212 patients (15.7%). Commonest causes of lymphadenopathy in different groups were found to be: In Group Ireactive hyperplasia 353(70.88%), Group IITubercular lymphadenitis 261(40.78%) and Group IIIMetastatic carcinoma 115(54.25%).Conclusion: It was concluded that different etiological factors play role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy. Work Attributed To –Department Of Pathology, Subharti Medical College, Meerut ,U.P., India. Financial SupportSubharti Medical College, Meerut, U.P., INDIA.

Review of the histopathologic patterns of superficial lymph node diseases, in Lagos (1991-2004)

This is a 14-year retrospective histopathologic study of 720 lymph node biopsies. The aim is to document the causes of lymphadenopathy, the age and sex distribution in Lagos. The materials consisted of slides and paraffin embedded blocks of all lymph node biopsy specimens received from within and outside Lagos University Teaching Hospital, Lagos. A total of 720 biopsies from 276 males and 444 females were analysed. Chronic non specific lymphadenitis 245 (34%), tuberculosis 125 (17.4%), metastatic lymph node lesions 242 (33.6%), and lymphomas 102(14.2%) were the common causes of lymph node enlargement. The commonest lymph node group affected was the cervical 283 (39.3%). Malignancy (47.8%) is the most common cause of superficial lymphadenopathy in Lagos metropolis. The age, sex and site prevalence agree with reports from other parts of Nigeria and Africa with minimal variations.

Surgical lymph node biopsies in University of Ilorin Teaching Hospital, Ilorin, Nigeria

To determine the diagnostic value of lymph-node biopsy, commonest causes of lymph node enlargement requiring biopsy and the usual nodes involved. A retrospective study of 169 lymph node biopsies representing 97% of lymph node biopsies and 3.2% of total biopsies specimen received at Pathology Department of University of Ilorin Teaching Hospital Ilorin, Nigeria over a 5 year period was undertaken. Tuberculous lymphadenitis (38%) and metastatic nodal involvement (25%) were the commonest causes of lymph node enlargement. Generalised lymphadenopathy occurred in 105 (62%) patients while localised enlargement was seen in 64{38%) of cases. The commonest sites of localised lymphadenopathy were axillary (38%), cervical (32%), inguinal (8%), and submandibular (8%). While axillary lymph node enlargements were mostly associated with tumour metastasis, cervical node enlargements were mostly associated with tuberculosis. Supraclavicular lymphadenopathy has the highest risk of malignancy. The result shows that tuberculous lymphadenitis and metastatic nodal malignancies are the commonest causes of lymph node enlargement in our environment. Reasons for this include the often involvement of lymph nodes in tuberculous infections {as lymphadenitis constituted the most frequent form of extra pulmonary tuberculosis} and cancer's metastasis. With an effective and nationwide immunisation against tuberculosis, health education on HIV infection coupled with early screening and detection of malignancies in generals, we hope this trend will change in the future. Lymph node biopsy remains an important and valuable diagnostic tool in evaluation of lymph node enlargement as it allows for the architecture of the gland to be viewed thereby given an accurate and concise diagnosis with very minimal risk to the patient.

Castleman disease mimicking a hepatic neoplasm

Castleman disease, or angiofollicullar hyperplasia, is a rare cause of lymph node enlargement. This most commonly occurs within the thorax, although rare extrathoracic presentations have been described. Only two cases with hepatic localization have been reported. We present a case of Castleman disease within the porta hepatis masquerading as a hepatic neoplasm.