Cervical Lymph Node Swelling Research Articles

Adult-onset Still's disease presenting lupus erythematosus-like facial erythema associated with Kikuchi's disease

ejd.2012.1855 Auteur(s) : Takako Miura m-takako@fmu.ac.jp, Toshiyuki Yamamoto Department of Dermatology, Fukushima Medical University, Fukushima 960-1295, Japan A 21-year-old female was admitted to our hospital, complaining of unknown fever, general fatigue, arthralgia, and skin rash. She had intermittent spike fever and cervical lymph node swelling. Physical examination showed urticarial facial erythema on the bilateral cheeks (figure 1A), persistent brownish plaques on the upper back, and linear [...]

Kikuchi–Fujimoto disease following vaccination against human papilloma virus infection and Japanese encephalitis

Kikuchi-Fujimoto disease (KFD) is a benign and self-limited syndrome, characterized by regional lymphadenopathy and fever. Although the pathogenesis of KFD remains unclear, infectious agents, autoimmune causes, and physicochemical factors have been suggested as triggers. However, KFD following vaccination has never been reported. We present a 14-year-old girl who suffered from fever and cervical lymph node swelling following simultaneous administration of human papilloma virus vaccine and Japanese encephalitis virus vaccine. The patient was diagnosed with KFD based on the histopathologic findings of a lymph node biopsy, and her fever and swelling resolved with oral corticosteroid therapy. Although the exact pathogenesis of the development of KFD following immunization remains unknown, this should be added to the list of potential triggers or factors associated with the development of KFD.

Epstein-Barr virus-associated lymphoproliferative disorder developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin’s lymphoma

Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations that develop as a consequence of immunosuppression in a recipient of a solid organ, bone marrow or stem cell allograft. The development of PTLDs is usually associated with Epstein-Barr virus (EBV) and the disorder is also termed EBV-associated lymphoproliferative disorder (LPD). The development of PTLD is a rare complication in autologous bone marrow/peripheral blood stem cell transplantation. In the present study, we report a case of EBV-associated LPD which developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin's lymphoma. A 51-year-old male presented with swelling of the left cervical lymph nodes. A biopsy revealed nodular sclerosis classical Hodgkin's lymphoma. Following four courses of ABVd (adriamycin, bleomycin, vinblastine, dacarbazine) therapy, the Hodgkin's lymphoma relapsed. CHASE (cyclophosphamide, etoposide, cytarabine, dexamethasone) therapy and autologous peripheral blood stem cell transplantation were performed. In the 128 days following the transplantation, lymph node swelling was noted and a biopsy specimen demonstrated EBV-associated LPD. The serum copy number of EBV-DNA was 2.7×10(3) copies/ml. The occurrence of EBV-associated LPD may be on the rise due to the increased number of patients undergoing immunosuppression therapy. The measurement of the serum EBV-DNA copy number and the detection of EBV-infected atypical lymphocytes using in situ hybridization are significant in establishing an early accurate diagnosis and initiating the correct treatment for EBV-associated LPD in patients with immunosuppression.

An ectopic ACTH-producing small cell lung carcinoma associated with enhanced corticosteroid biosynthesis in the peritumoral areas of adrenal metastasis

A 60-year-old Japanese male presented with swelling of bilateral cervical lymph nodes was subsequently diagnosed as the late stage of primary small cell lung carcinoma (SCLC). He was then treated with cisplatin and irinotecan as first-line chemotherapy, but hypokalemia with muscle weakness of the bilateral legs became gradually noticeable following two months of effective chemotherapy. A computed tomography (CT) scan revealed enlargement of bilateral adrenal glands and abdominal and mediastinal lymph nodes, though primary lung tumor remained the same in size. An ectopic ACTH-producing syndrome (EAS) was subsequently revealed by the following endocrinological studies. Hypokalemia was clinically improved by the treatment with metyrapone and the second-line chemotherapy with amrubicin for SCLC was started, but the patient died 12 days after the second-line chemotherapy. Post-mortem examination revealed ACTH immunoreactivity in tumor cells of all the metastatic lesions. Non-neoplastic adrenal cortex demonstrated hyperplasia associated with lipid depletion and marked expression of steroidogenic enzymes, especially in cortical cells around tumor infiltration, suggestive of paracrine ACTH stimulation of cortisol production. This is the first report evaluating expression of steroidogenic enzymes in adrenal cortex especially adjacent to the adrenal metastasis in the patients with EAS due to SCLC. These findings suggest that ACTH producing adrenal metastasis can induce EAS more frequently and severely, and that the symptoms and examination of EAS should be monitored carefully in the patients with adrenal metastasis of SCLC.

Impact of HIV on Head and Neck in South India: A Cytology Study

ABSTRACTSouth India is now endemic for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Government and other organizations statistics are not correlating with our laboratory records. We are getting increased HIV-positive cases for fine needle aspiration cytology (FNAC) at our laboratory. Our past statistics of cytology lesions are altered due to opportunistic infections in HIV-positives, so, we decided to find the real incidences of various opportunistic diseases in HIV-positives pertaining mainly to head and neck only, because, this part of body is the major contributor for our fine needle aspiration cytology workload.Conducted free ELISA test for all, prior to FNAC procedure to separate immune competent, then study was conducted using available resources in well-planned procedure for definitive diagnosis.In 1 year, we did 3,407 FNAC, 2,283 (67%) FNAC cases were belongs to head and neck. We got 359 (10.53%) HIV-positive patients including 317 (88.3%) from head and neck, male to female ratio was 1.55:1, cervical lymph node swellings were 89.2%, followed by oral cavity 6%. Youngest patient was 7-year-old and oldest was 54-year, mean age was 26.5 years.It is very difficult to reduce the incidences and the spread of HIV infection by government/other organizations efforts, needs vigorous effective effort to educate youths of all sections, which is remote for India.How to cite this articleRamachandra NB. Impact of HIV on Head and Neck in South India: A Cytology Study. Int J Head and Neck Surg 2012;3(1):11-14.

Adult-onset Still's Disease Complicated by Autoimmune Hepatitis: Successful Treatment with Infliximab

A 17-year-old woman was previously diagnosed with autoimmune hepatitis (AIH) by liver biopsy. Adult-onset Still's disease (AOSD) was subsequently diagnosed on the basis of high fever, arthralgia, erythema, leukocytosis (>80% granulocytes), cervical lymph node swelling, splenomegaly, and hyperferritinemia. Her symptoms and liver dysfunction improved with prednisolone of 60 mg daily and subsequently methotrexate was added. However her symptoms and liver dysfunction relapsed when prednisolone was tapered to 20 mg/day. Therefore infliximab was introduced additionally and her symptoms and liver dysfunction subsided. To our knowledge, this is the first reported case of AOSD with AIH diagnosed by liver biopsy.

Sub-acute Demyelinating Polyradiculoneuropathy as an Initial Symptom of Peripheral T Cell Lymphoma, Not Otherwise Specified (PTCL-NOS)

Here we report the first case of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), who initially presented with peripheral neuropathy. Nerve conduction, cerebral spinal fluid studies and his clinical course were compatible with sub-acute demyelinating polyradiculoneuropathy. In addition, left cervical lymph node swelling was observed on admission. Diagnosis of PTCL-NOS was made by the histological, immunohistochemical, and Southern blot analyses on the biopsy specimen from the enlarged lymph node. Combination chemotherapy composed of cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP) was effective for polyneuropathy as well as for lymphoma. Several antibodies relating to paraneoplastic syndrome such as Ma1, Ma2, Amphiphysin, CV2, Ri, Yo and Hu were all negative. Because sural nerve biopsy performed prior to CHOP therapy revealed no infiltration of lymphoma cells, immune dysfunction mediated by some cytokine or unidentified autoantibody related to PTCL-NOS was thought to be involved in the polyradiculoneuropathy.

Erstdiagnose einer Tuberkulose im HNO-Bereich

In Germany tuberculosis has a decreasing incidence. The lung is the most common focus, whereas head and neck manifestation occurs rarely. Between 1997 and 2010 all patients with initial diagnosis of tuberculosis of the head and neck region were retrospectively reviewed at the University Hospital of Bonn, Germany. 38 patients (24 female, 14 male, median age 43.5±19.7 years) were analysed. More than 60% were of foreign nationality. The majority of patients (87% ) presented with an unspecific cervical lymph node swelling. Extranodular manifestations (maxillary sinus, middle ear, larynx, tonsil) leading to organ specific symptoms rarely occurred. In only 3 cases a mycobacterial infection was suspected before surgery. Only the knowledge of different manifestation patterns as well as an accurate anamnesis of infectious diseases can lead to the tentative diagnosis of tuberculosis prior to surgery.

A Case of Kikuchi's Disease Associated with Hemophagocytic Syndrome

Kikuchi’s disease and hemophagocytic syndrome have the clinical similarity in initial presentations, but present different clinical course and prognosis. Kikuchi’s disease usually have a self-limiting clinical course, but hemophagocytic syndrome can be fatal. It is important to make differential diagnoses and treat properly. We report a case of 18 year old boy who was admitted to the hospital with two weeks history of fever and progressive cervical lymph node swelling. Cervical lymph node biopsy showed the typical necrotizing lymphadenitis of Kikuchi’s disease. There were signs of histiocytosis and hemophagocytic phenomenon in the bone marrow. The etiology, treatment, and prognosis of Kikuchi’s disease with hemophagocytic syndrome are discussed.�

CD30-positive anaplastic variant diffuse large B cell lymphoma: a rare case presented with cutaneous involvement

A 67-year-old man suffered from a left cervical lymph node swelling and tenderness. Biopsy of the cervical lymph node showed pleomorphic large cells containing large atypical nuclei. Immunohistochemical stains of these cells were positive for CD30, but negative for CD3 and CD20. After the biopsy, his left cervical skin was ulcerated. Biopsy of the left cervical skin was performed. Large pleomorphic cells with constricted nuclei and Reed-Sternberg-like cells existed in the dermis and epidermis. Immunohistochemical stains of the former cells were positive for CD30, CD45 and PAX5, but negative for CD3, CD10, CD20, CD15, Bcl-2, EBER ISH, EMA and ALK. He was diagnosed with diffuse large B cell lymphoma, anaplastic variant. He achieved complete remission with CHOP chemotherapy. CD30-positive DLBCL, anaplastic variant is a rare B cell lymphoma. Most of the patients presented with primary nodal disease, and skin involvement of lymphoma is very rare. This is the report of a rare case of CD30-positive DLBCL, anaplastic variant, with both nodal and skin lesions.

ＩｇＧ４関連唾液腺疾患例

Immunoglobulin G4 (IgG4) is thought to be involved in inflammatory IgG4-related disease pathology typically diagnosed clinically as Mikulicz’s disease or autoimmune pancreatitis. A recent proposal classifies IgG4-related disease as systemic, and we report a case believed to be IgG4-related disease. A 76-year-old man was first seen on May 30, 2008, for submental swelling gradually developing since autumn 2007. Physical findings were a dry oral cavity, submental swelling and lymph node swelling. Magnetic resonance imaging (MRI) showed mediastinal lymph node hyperplasia and blood tests increased soluble IL-2 receptors, suggesting malignant lymphoma. Submaxillary gland biopsy on August 8, 2008, showed no clear malignant findings histopatholpgically, but noted chronic sialadenitis. IgG4 immune staining showed IgG4-positive plasmacytes infiltration and blood tests confirmed increased IgG4. Based on these findings, we diagnosed the case as IgG4-related disease, initiating oral prednisolone at 40 mg/day. Submaxillary gland swelling decreased significantly and soluble IL-2 receptors returned to normal. When MRI showed that submaxillary gland and lymph node swelling had been eliminated, prednisolone administration was gradually decreased. Subjects with IgG4-related disease may have bilateral cervical lymph node swelling and increased soluble IL-2 receptor levels, and this case suggests the importance of considering IgG4-related disease in differential diagnosis.

Clinically controlled study on children’s infectious mononucleosis treated by Chinese medicine

To evaluate the clinical efficacy and safety of Chinese drugs for the treatment of children's infectious mononucleosis (CIM). Sixty CIM patients were assigned into the treated group and the control group, patients in the treated group were administered with Chinese herbal decoction, and those in the control group were treated with intravenous dripping of ganciclovir 10 mg/kg per day, for a treatment course of 14 days. The total effective rate was 96.0% in the treated group and 97.1% in the control group, showing insignificant difference between groups. The efficacy in the treated group was superior to that in the control group on the fever clearance time (3.0+/-1.5 days vs 4.9+/-3.9 days ) and the disappearance time of cervical lymph node swelling (0.8+/-1.0 score vs 1.5+/-1.2 score), showing statistical significance (all P<0.05). T-cell subsets were markedly improved in both groups after treatment. Adverse reaction occurred in four cases of the control group. Using Chinese herbs for clearing heat, removing toxin, activating blood circulation, and dissolving stasis is effective and safe for the treatment of CIM. It can effectively improve the clinical symptoms and shows a certain effect on immune regulation.

Clonal B‐cell population in a reactive lymph node in acquired immunodeficiency syndrome

A 40-year-old female, HIV positive, stage C, since 4 years, complained of a right cervical lymph node swelling. Two years before, the patient had been diagnosed with follicular B-cell non-Hodgkin lymphoma (FL); she had been treated with four cycles of multiagent chemotherapy plus rituximab, the last cycle being administered 10 months before coming to our attention. An ultrasound (US) guided fine-needle cytology (FNC) showed an atypical lymphoid cell proliferation. The phenotype evidenced by flow cytometry (FC) analysis was D5: 10%, CD19: 49%, CD23: 10%, FMC7: 0%, CD10: 40%, CD10/19: 40%, lambda light chain 40%, kappa light chain 0%. FDG-positron emission tomography (PET/CT) scan showed positivity in the corresponding cervical area. Since low LDH values and a reduced lymph node size were observed, the lymph node was therefore excised; the histology revealed a reactive hyperplastic lymph node with florid follicular pattern. A subsequent PCR analysis, performed on DNA extracted from a whole histological section, did not evidence IgH rearrangement. The patient is currently undergoing strict clinical and instrumental follow-up, including PET every 3 months; after 13 months, she is alive without recurrence of lymphoma. Clonal B-cell populations in non-lymphomatous processes have been described in mucosa-associated lymphoid cell populations and reactive lymph nodes, and are considered non-malignant, antigen driven, proliferations of B-lymphocytes determined by an abnormal response to bacterial or viral antigen stimulation. The present case occurred in an HIV patient and was clinically complex because of the patient's history of FL. This experience suggests much attention in the evaluation of radiological, cytological, and FC data and in clinical correlation in patients suffering from autoimmune or immunodeficiency syndromes.

Salivary duct carcinoma of the parotid gland: clinical and MR features in six patients

This study reports the clinical and MR features of salivary duct carcinoma (SDC) of the parotid gland, which is a rare and highly malignant tumour. We assessed retrospectively the clinical and MR features of six patients with histologically proven SDC of the parotid gland. The five men and one woman, ranging in age from 65-71 years (mean, 67 years), had undergone MRI before surgery. All patients presented with parotid masses and four patients had facial paralysis. Two had been aware of the parotid mass for more than 10 years. On MRI, all of the tumours had an ill-defined margin along either the entire circumference or part of the circumference. Four tumours showed infiltration into the subcutaneous or parapharyngeal space. Two tumours showed a wholly solid internal content, and four tumours had varying proportions of cystic content. The signal intensity of the solid portion was low to intermediate on both T(1) weighted and T(2) weighted images. Three patients showed multiple cervical lymph node swellings. Although SDC can show non-specific MRI findings, the combined findings (e.g. low-to-intermediate signal intensities on T(2) weighted images, ill-defined boundaries, infiltration into the surrounding fat space, facial nerve paralysis and associated cervical lymphoadenopathy, seem to suggest a high-grade malignancy.

Reversible infliximab-related lymphoproliferative disorder associated with Epstein-Barr virus in a patient with rheumatoid arthritis

A 63-year-old woman with active rheumatoid arthritis (RA) had been treated with methotrexate and prednisolone. She developed cervical lymph node swelling 30 months after the initiation of infliximab therapy. A computed tomography revealed cervical and mediastinal lymph node swelling and multiple nodules (up to 13 mm in diameter) in the lungs. A lymph node biopsy showed infiltration of numerous Hodgkin-like and Reed-Sternberg-like cells. Immunohistological studies showed that these cells were positive for CD15, CD30, and Epstein-Barr virus (EBV) latent membrane protein. In site hybridization revealed the presence of EBV RNA in the nuclei of these cells. EBV DNA was detected in the biopsy specimen by southern blot analysis. She was diagnosed as having EBV-associated lymphoproliferative disorder (LPD). Immunodeficiency-associated LPD related with infliximab therapy was considered. Cessation of infliximab therapy only led to dramatic regression of LPD. This case illustrates that EBV-associated LPDs can occur as part of infliximab adverse effects in patients with RA.

Initial symptoms of malignant thyroid tumors: the effect of age and sex in an iodine-deficient region. Experiences with 1116 patients

Initial symptoms of thyroid cancer were collected and analysed for 1116 patients with thyroid cancer in an iodine-deficient region, retrospectively for the period 1960-80 (604 patients), prospectively for 1981-87 (512). Using the WHO classification, 56.1% of patients had papillary, 32.7% follicular, 4.8% C-cell, 3.7% anaplastic and 2.7% various other malignant tumours. In 40% of all patients the initial sign had been a solitary intrathyroid nodule. Cervical lymph node swelling as initial sign had been significantly more frequent in men (21.1%) than in women (10.3%; P less than 0.003). In patients aged under 40 years the cervical lymph node signs were three times as common as among those over 50 years. Distant metastases as initial sign of papillary carcinoma were seen only in those over 60 years. Tumour stages T3 and T4 were seen significantly more frequently in over 60-year-old (42.2%) than under 40-year-old (25.1%; P less than 0.001), independent of histological type. Composition and initial signs of this patient cohort in an iodine-deficient region differed only slightly from those in an iodine-rich region.

Lésion intracrânienne révélatrice d’une maladie de Hodgkin

The central nervous system's (CNS) involvement is uncommon in Hodgkin's disease (HD) and usually occurs in patients with relapsing disease many years after the initial diagnosis. An isolated involvement of the CNS is extremely rare and therefore, difficult to diagnosis. We report the case of a 27-year-old woman with seizure and a left cerebrodural mass on the cerebral imaging; secondarily, she developed cervical lymph node swelling; histological examination of the node revealed HD of the nodular sclerosis type. The dural lesion resolved after chemotherapy for HD.

Salivary gland tumours in kaduna; a ten-year review.

The aim of this paper was to review salivary gland tumours seen in Kaduna with emphasis on their prevalence, clinical presentation and management outcome. A retrospective study of 224 patients with salivary gland tumours seen and managed at the Maxillo-Facial unit of the Ahmadu Bello University Teaching Hospital Kaduna over a period of 10 years was carried out using information from patients' records. Of the 224 patients treated, 54% were males and 46% were females. Salivary gland tumours were seen and treated in all age group with a peak incidence between the third and fourth decades. About fifty nine percent (58.9%) of cases treated were adenomas, 34.4% carcinomas, 5.4% carcinoma ex pleomorphic and 1.3% were non-epithelial tumours. The palate was the most common site of tumour occurrence while the parotid was the major salivary gland affected. Patients with salivary gland adenomas presented most often with painless swellings while those with carcinomas had painful swellings with cervical lymph node swelling and ulceration as the presenting complaints. Eighty percent of malignant salivary gland tumours metastasized to the lungs. Treatment of tumours was surgical, combined with radiotherapy. It appears that salivary gland tumour are not as rare among blacks as previously believed. It is rarer at the extremes of age with a peak incidence in the third and fourth decades. Adenomas of the salivary glands are more common than carcinomas. Keywords: Review, Salivary glands tumours, Nigeria Annals of Biomedical Science Vol. 2 (2) 2003: pp. 74-81

Preauricular malignant lymphoma masqurading as benign pleomorphic adenoma — A rare tricky presentation

Lymphoma in the head neck area most commonly present as cervical lymph node swelling followed by tonsillar enlargement but the presentation as sole preauricular swelling without systemic involvement is a very rare finding. Here we present a case of malignant lymphoma Grade I, presenting as a single prauricular swelling masquerading as a benign pleomorphic adenoma, in a 24 year old girl.

Frequency of Adverse Events Associated with Intravenous Immunoglobulin Therapy in Patients with Pemphigus or Pemphigoid

Intravenous immunoglobulin (IVIG) therapy is widely used in immune-mediated diseases as an immunomodulatory agent and is considered to be a safe biologic agent. To determine the frequency of adverse events associated with IVIG therapy in patients with pemphigus and pemphigoid. We retrospectively reviewed data on patients treated with IVIG for pemphigus and pemphigoid over a 10 year period. Patients had pemphigus vulgaris, pemphigus foliaceus, mucous membrane pemphigoid, or bullous pemphigoid. IVIG was given according to a published protocol at a dose of 2 g/kg administered over 3-5 days at prescribed intervals. Patient records were reviewed for information on sex, age, duration of treatment, number of cycles given, number of days each patient received IVIG, weight of each patient, IVIG dose each patient received per infusion, and early or delayed adverse effects reported by patients or observed by healthcare providers. We identified 9892 infusions given to 174 patients. Headaches were the most common adverse effects; they were observed during 886 (8.9%) infusions and involved 123 (70.6%) patients. The incidence of other minor adverse effects, including fatigue, nausea, vomiting, chills, urticaria, swollen glands, hoarseness, thoracic discomfort, and palpitations, was 0.57-3.4% per infusion and 0.04-1.3% per patient. Hoarseness of voice and swelling of cervical lymph nodes have not been previously reported. Acute renal failure occurred in one patient and was the only major adverse effect observed. None of the patients required hospitalization, and there were no deaths. Adverse events associated with IVIG therapy are usually mild and self-limiting. The incidence of serious adverse events is low. Identification of risk factors and close monitoring of high-risk patients throughout the therapy are likely to decrease the occurrence of rare serious and less likely fatal adverse effects.