Chronic Granulomatous Lymphadenitis Research Articles

The Importance of Diagnostic Mediastinoscopy in Patients with Mediastinal Lymphadenopathy

Objectives: Mediastinoscopy is a safe and invasive diagnostic method allowing to obtain sufficient tissue samples in the diagnosis of many malignant and benign intrathoracic diseases. In this study, it was aimed to determine the importance of mediastinoscopy in diagnosing mediastinal diseases and also provide patient data in the resolution of mediastinal diseases. Methods: Between January 2016 and December 2020, 76 cases of mediastinal lymphadenopathy that could not be diagnosed by other diagnostic methods were evaluated. Results: 64 (84,2%) of these 76 cases were diagnosed by mediastinoscopy. 12 cases (15.7%) were reported as reactive lymphoid hyperplasia. Since the definitive diagnosis of these cases could not be proven, they were considered as false-negative. Histopathological examination revealed chronic granulomatous lymphadenitis in 16 cases, non-necrotizing granulomatous lymphadenitis in 27 cases, metastasis of malignant disease in 18 cases, and lymphoma in 2 cases. In our study, the sensitivity of mediastinoscopy was determined as 84.2%. Neither mortality nor morbidity was detected in our cases. Conclusion: As a result, mediastinoscopy continues to maintain its traditional place for patients that cannot be diagnosed, because it is reliable and less invasive.

ATYPICAL PRESENTATION OF THYROID MALIGNANCIES: A CASE SERIES

Introduction: Differentiated thyroid cancer mainly metastasizes to regional lymph nodes and rarely to distant organs. Papillary thyroid carcinoma can metastasize via lymphatic pathway and follicular thyroid neoplasms through vascular channels. Here we present 3 cases with atypical presentations and synchronous/metachronous primary tumours (non-endocrine). Case Reports: Case 1: A 43-year-old female with no known comorbidities presented with right shoulder pain. X-ray showed a missing rib incidentally. A CT thorax suggested metastatic bony mass. PET CT for finding primary malignancy showed uptake in thyroid. Her TFT was normal. FNAC thyroid with bone biopsy confirmed follicular carcinoma thyroid with bone metastasis. Case 2: A 33-year-old male presented with hematuria was diagnosed to have renal cell carcinoma. He underwent right radical nephrectomy. A follow up PET CT as per protocol showed hypermetabolic hypodense nodule in the left lobe of thyroid gland. His TFT showed hypothyroidism, but patient had no related complains. Biopsy confirmed papillary thyroid carcinoma. Case 3: A 48-year-old female came with fever and cervical lymphadenopathy. USG neck showed TIRADS 4 lesion with retrosternal extension. FNAC taken from the lymph node showed chronic granulomatous lymphadenitis suggestive of TB with Mantoux test being positive. She was started on ATT but thyroid lesions still persisting with lymphadenopathy. She underwent total thyroidectomy and biopsy showed infiltrating neoplasm arranged in papillary pattern. Here, her TB was masquareding the thyroid malignancy. Conclusion: The clinical presentation of thyroid metastases to uncommon sites are difficult to diagnose. Thyroid malignancies presenting with atypical features are not uncommon, but at times diagnosis and timely management is difficult in such cases.

Retrospective Analysis of Neck Masses Diagnosed by Histopathology from Chattogram General Hospital

Background: Neck masses are found in all age groups from many causes, ranging from congenital to acquired pathology. There is a wide variation in the presentation of neck masses concerning its site of origin, clinical presentation, and the nature of the progression of the disease. This study was performed to have an idea about the prevalence of various neck masses according to age and sex so that it would help us in diagnosing the neck masses. Materials and methods: This retrospective study was performed in the Department of Otolaryngology and Head Neck Surgery, Chattogram General Hospital, Chattogram from July 2018 and June 2019, over 97 patients presented with neck mass. Results: Of 97 cases 69.1% were female and range from 7-77 years. The maximum case holding age group was 21- 30 years (26.8%). The histopathological diagnosis of the neck masses was inflammatory in 68 (70.1%), congenital in 5 (5.2%) and neoplastic in 24 (24.7%) cases. Chronic granulomatous lymphadenitis was the most common inflammatory lesion (50.5%) and a branchial cyst was the most common congenital mass (2.2%). Neoplastic masses were malignant in 10 (10.3%) and benign in 14 (14.4%) cases. The most common malignant neoplastic mass was a follicular carcinoma (6.2%), and the most common benign neoplastic mass was goitre (12.4%). Conclusions: Cervical lymphadenopathy was the most commonly encountered neck mass. Most of the neck masses are benign. Out of these cervical lymph nodes, tubercular lymphadenopathy was most common. JCMCTA 2022 ; 33 (1) : 21-24

Importance of fine needle aspiration cytology in revealing the spectrum of axillary swelling: An experience with 30 cases

FNAC plays an important role in the early diagnosis of the axillary swelling. This study was conducted to document the spectrum of lesions on the patients that came for FNAC with the complain of axillary swelling. Present study was carried out at the Department of Pathology. A total of 30 cases of axillary swelling which were referred for FNAC in the department of Pathology, over the period of 3 months were retrospectively evaluated. All the stained slides of the cases were also reviewed.: From 30 cases there were 13 males and 17 females. On examining the stained slides maximum number of cases presented with chronic granulomatous lymphadenitis followed by Reactive lymphadenitis , Lipoma, Ductal carcinoma metastasis of breast in axillary lymphnode, chronic non-specific lymphadenitis, One unusual case of Hydatid cyst who presenting with axillary swelling was also diagnosed. : FNAC is an important tool in differentiating benign and malignant lesions thus, helps in the proper management of the disease.

STUDY OF LYMPH NODE CYTOLOGY IN HIV INFECTED PATIENTS

Background and Aim: Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. This study was performed to evaluate the role of FNAC as a cytological investigative tool in the diagnosis of various lesions in HIV lymphadenopathy.
 Material and Methods: This study was carried out in Tertiary care Institute of India, over a period of one year. Total 50 cases of HIV lymphadenopathy patients were participated in the study after having signed the Informed Consent Form. Diagnosis of HIV was done by enzyme linked immunosorbant assay (ELISA) test, followed by the CD4 counts by BD FACS Count system in HIV positive patients. FNAC procedure was performed as an OPD procedure in cytology OPD of pathology department.
 Results: Most common site of HIV lymphadenopathy is cervical lymph node 40 (80%), followed by supraclavicular 6(12%) followed by axillary lymph node 4(8%). The most common lesion found was mycobacterial infection 22(44%), followed by reactive lymphadenitis 15(30%). Non-specific chronic granulomatous lymphadenitis in 10(22%) and 3(6%) cases of acute suppurative lymphadenitis. CD4 count more than 500 cells/ µL was seen in 9 (18%) cases of reactive lymphadenitis and 4 (8%) cases of chronic granulomatous lymphadenitis. Patients with tubercular infection had CD4 count between 200- 499 cells/ µL in 12 (24%) cases and less than 200 in 10 (20%) cases.
 Conclusion: FNAC is relatively inexpensive and valuable tool for identification of opportunistic infections, neoplastic lesions and non-neoplastic lesions. It may spare patients lymph node excision and enable immediate treatment of specific infection. This procedure is readily repeatable and can be used for follow up during and after treatment.
 Keywords: Human immunodeficiency virus, lymphadenopathy, Non-specific chronic granulomatous lymphadenitis, tuberculosis

Systemic lupus erythematosus associated with sarcoidosis: Case report

BackgroundThe association between systemic lupus erythematosus (SLE) and sarcoidosis has been considered as extremely rare. Most often, sarcoidosis coexists with Sjögren's syndrome. Researching the literature, it seems that the association of SLE and sarcoidosis is much more frequent than previously thought. Aim of the workWe present a case of a Serbian woman who was diagnosed with coexisting sarcoidosis and long-standing SLE. Case presentationThe 40 years old SLE patient was in long-standing remission on oral prednisolone (10 mg/day) and hydroxychloroquine (HCQ) (400 mg/day). She presented with fatigue, chest pain, and dry cough. Chest computerized tomography (CT) showed hilar and mediastinal lymphadenopathy. The biopsy had been performed and results showed sarcoidosis. Diagnosis has been confirmed: eosinophilic granulomas without central necrosis morphologically corresponding to chronic granulomatous lymphadenitis like sarcoidosis. Thereafter, the patient was hospitalized. No new symptoms appeared, and the physical examination was unremarkable. Serum calcium was elevated (2.75 mmol/l), anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA) and anti-Ro antibodies were positive. Angiotensin converting enzyme (ACE) level was high normal (51 IU/L) and QuantiFERON-TB Gold test negative. The dose of prednisolone was increased to 40 mg/day with HCQ and the patient was discharged from hospital. On follow-up the patient improved with reduction of the steroid dose. ConclusionThe association of SLE and sarcoidosis should be considered even though it is reported to be extremely rare. May be the real incidence of these combinations is underestimated. More research about genetics and pathogenesis is needed to completely understand these conditions.

High prevalence of subclinical paratuberculosis in buffaloes (Bubalus bubalis) in Maranhão, Brazil.

Paratuberculosis is an infectious, chronic, and incurable disease that affects ruminants, causing enteritis and chronic granulomatous lymphadenitis, characterized by malabsorption syndrome, its agent is the Mycobacterium avium subsp. paratuberculosis (MAP). Thus, the objective of this work was to identify and characterize MAP in buffalo herds slaughtered in Baixada Maranhense region. Samples of intestines, mesenteric lymph nodes, and ileocecal valves were collected from 115 buffaloes slaughtered at Baixada Maranhense slaughterhouses to perform the diagnosis by histopathological examination using staining with Hematoxylin and Eosin (H&E) and Ziehl-Neelsen, bacterial isolation, and real-time PCR. In the histopathology by H&E staining, there was evidence suggestive of paratuberculosis in 30% (31/115) of the buffaloes. With Ziehl-Neelsen staining, acid-fast bacilli (AFB) were visualized in 27% (26/115) of the tissue samples analyzed. MAP was isolated in 4.3% (5/115) of the fecal samples subjected to bacterial culture. The samples inoculated in HEYM with mycobactin J produced colonies identified with MAP according to their own morphological characteristics such as round, white, smooth and slightly rough, alcohol-acid staining, and slow growth with 8weeks of incubation and mycobactin dependence. The agent confirmation was performed in five bacterial isolates (4.3%) and 15 (13%) fragments of jejunum, ileum, and mesenteric lymph node by the IS900 real-time PCR technique. The results of the present study demonstrate the subclinical occurrence of paratuberculosis in flocks of buffalo slaughtered in slaughterhouses of Baixada Maranhense.

Triple infection with Cryptococcus, varicella-zoster virus, and Mycobacterium abscessus in a patient with anti-interferon-gamma autoantibodies: a case report

BackgroundThe most common infection in patients positive for anti-interferon-gamma autoantibodies (anti-IFN-γ AAbs) is disseminated nontuberculous mycobacterial (dNTM) infection. Here, we report a rare case of triple infection caused by Cryptococcus, varicella-zoster virus (VZV), and nontuberculous mycobacterium in a patient with anti-IFN-γ AAbs.Case presentationA 53-year-old Thai man presented with a progressively enlarging right cervical mass with low-grade fever and significant weight loss for 4 months. He also developed a lesion at his left index finger. A biopsy of that lesion showed granulomatous inflammation with yeast-like organisms morphologically consistent with cryptococcosis. Serum cryptococcal antigen was positive. Histopathology of a right cervical lymph node revealed chronic granulomatous lymphadenitis, and the lymph node culture grew Mycobacterium abscessus. One month later, he complained of vision loss in his left eye and subsequently developed a group of painful vesicles at the right popliteal area of S1 dermatome. Lumbar puncture was performed and his cerebrospinal fluid was positive for VZV DNA. His blood test for anti-HIV antibody was negative. Anti-IFN-γ AAbs was positive, but test for anti-granulocyte-macrophage colony-stimulating factor autoantibodies (anti-GM-CSF AAbs) was negative. He was treated with amphotericin B plus fluconazole for cryptococcosis; a combination of amikacin, imipenem, azithromycin, and levofloxacin for dNTM infection; and, intravenous acyclovir for disseminated VZV infection. After treatment, our patient’s fever and cervical lymphadenopathy were subsided, and his vision and visual acuity were both improved.ConclusionsThis is the first case of triple infection with cryptococcosis, VZV, and dNTM in a patient who tested positive for anti-IFN-γ AAbs and negative for anti-GM-CSF AAbs. This case will increase awareness and heighten suspicion of these infections in patients with the described presentations and clinical characteristics, and this will accelerate diagnosis and treatment.

Cytological evaluation of lymphadenopathy in HIV seropositive patients

Cytological evaluation of lymphadenopathy in HIV seropositive patients - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.002, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Clinical profile of cervical lymphadenopathy and to find diagnostic efficacy of fine-needle aspiration cytology, ultrasonography and histopathological examination

<p class="abstract"><strong>Background:</strong> Cervical lymphadenopathy is the sign of a disease process which involves lymph nodes that are anomalous in uniformity and dimensions. It is very vital to exercise fine-needle aspiration biopsy, histopathological investigation, and ultrasonography for the diagnosis of palpable lesions.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 12-month duration from January 2018 to December 2018 in 61 patients presenting with cervical lymphadenopathy admitted in the ENT Department at Geetanjali Medical College and Hospital, Udaipur. </p><p class="abstract"><strong>Results:</strong> In biopsy, most common diagnosis was chronic granulomatous lymphadenitis i.e. in 62.3% of the patients. As compared to biopsy, fine-needle aspiration cytology (FNAC) showed chronic granulomatous lymphadenitis in 46% of the patients, with overall sensitivity of 91.1%, and specificity of 60.0%. and accuracy of 88.5%. Whereas ultrasonography (USG) reported, 64% cervical lymphadenopathy in patients, with overall sensitivity came out to be 91.1%, specificity to be 40.0%, accuracy was 86.9%.</p><p class="abstract"><strong>Conclusions:</strong> Present study showed that biopsy is the gold standard procedure for diagnosis of cervical lymphadenopathy lesions followed by FNAC, USG. Tuberculous lymphadenitis was most common diagnosis made by the diagnostic modalities.</p>

SUN-588 Primary Tuberculosis of the Thyroid Gland: A Case Series

Background:Tuberculosis (TB) of the thyroid gland is a rare occurrence even in regions where TB is endemic. This affects about 0.1% of the population with TB and remains to be underdiagnosed due to the rarity of the condition. Case: We report three cases of TB of the thyroid. The first patient is a 60 year old female who presented with anterior neck mass with no obstructive symptoms, neck pain or fever. There were no signs nor symptoms of hyperthyroidism or hypothyroidism. She also has no history of tuberculosis. Ultrasound showed multiple thyroid nodules. Ultrasound guided FNABof the left nodule was done revealing chronic granulomatous inflammation with necrosis. The second case is a 60 year old male presenting with a history of painful, marble-sized right neck mass for 1 month accompanied by occasional low grade fever, weakness and weight loss. An ultrasound guided FNAB was performed revealing polymorphic lymphoid cells with occasional giant cells consistent with granulomatous thyroiditis. The third case is a 37 year old female presenting with an enlarging anterior neck mass with concomitant abscess. She complained of neck pain and dysphagia. Incision and drainage of the abscess was done. Microbiological studies revealed negative AFB with chronic granulomatous lymphadenitis and caseation necrosis. Mycobacterium culture and polymerase chain reaction were negative as well. Ultrasound of the thyroid gland revealed a left thyroid mass measuring 2.1 x 3.5 x 4.1 cm. Result: The first case was referred to an infectious disease specialist but was lost to follow up. The second casecompleted treatment for 6 months with anti Koch’s medications and on repeat ultrasound, there was decrease in the size and number of the nodules. The third case underwent thyroid lobectomy with histopathologic criteria for TB hence a diagnosis of thyroid TB was made. The patient was given anti-Kochs treatment. Conclusion: Though rare, tuberculosis of the thyroid should be one of the differential diagnoses of patients presenting with neck masses in communities where the prevalence of TB is high even in patients with no history of TB.

Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy

PurposeThe aim of this work is to evaluate the reliability and diagnostic accuracy of fine needle aspiration cytology (FNAC) of cervical lymph nodes with an emphasis on discordant cases between the cytology and the histopathology. Patients and methodsThis retrospective study was conducted on 157 selected patients with cervical lymphadenopathy that had undergone FNAC. Cervical nodal enlargement was the first clinical manifestation of the patients in all cases. Hypocelluar slides were excluded from the current study. The cytopathological diagnoses were compared with the histopathological results of the same excised nodes. For all discordant cases, special attention was focused on the cytomorphological features. Diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and discordance rate were calculated. ResultsThe cytological diagnoses were found to be benign in 48 cases (30.6%) and malignant in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2% (129/157), while the overall discordance rate was 17.8% (28/157). The diagnostic accuracy of reactive lymphoid hyperplasia, chronic necrotizing lymphadenitis, chronic granulomatous lymphadenitis, metastatic carcinoma, Hodgkin lymphoma, and Non Hodgkin lymphoma was 85%, 83.3%, 70%, 100%, 77.8%, and 75%, respectively. ConclusionThe overall diagnostic accuracy of FNAC of cervical lymph nodes was 82.2% while the overall discordance rate was 17.8%. The evaluation of FNA in patients with no previously diagnosed malignancy should be interpreted by an experienced cytopathologist in the context of clinical, radiological, and laboratory finding and if any of these findings is suspicious, further investigation is justified to overcome the limitations and pitfalls of the cytomorphological features when applied alone.

Porcine circovirus-associated disease in weaner pigs in Western Australia

To report the occurrence and pathology of porcine circovirus type 2 (PCV2)-associated disease (PCVAD) of postweaning pigs in two Australian pig herds. Mortality data from two commercial piggeries that experienced higher than normal postweaning illthrift and mortalities were examined. Gross and histopathological examinations were performed on the index cases, and at weekly intervals thereafter for a period of 10 weeks. Specimens were submitted to the laboratory for routine diagnostic testing and for exclusion of porcine reproductive and respiratory syndrome virus (PRRSV). The genomes of two strains of PCV2 isolated during testing were sequenced. Mortality rates in weaned, 5-12-week-old pigs spiked significantly during mid to late 2007. This increase in the mortalities was mainly attributed to salmonella-associated diarrhoea and illthrift. Salmonellosis was diagnosed in 73/110 cases inclusive of both piggeries. Many pigs also had chronic granulomatous lymphadenitis and diffuse histiocytic interstitial pneumonia consistent with PCVAD and associated with varying amounts of PCV2 antigen and inclusion bodies. All samples tested for PRRSV were negative. Sequence analysis of the PCV2 isolates showed strain differences between piggeries. This report describes the first outbreaks of PCVAD in growing pigs in Western Australia (WA) and describes lesions not previously seen in this laboratory. It also describes the first isolation of a PCV2 group 1 virus in WA associated with PCVAD. Although the outbreaks of PCVAD occurred with concurrent salmonellosis, the two diseases were unrelated. Neither of the outbreaks met the Australian case definition for the diagnosis of postweaning multisystemic wasting syndrome.

Johne's Disease in a Free-Ranging White-tailed Deer from Virginia and Subsequent Surveillance for Mycobacterium avium subspecies paratuberculosis

Johne's disease (paratuberculosis) was diagnosed in a 2-yr-old, male, free-ranging white-tailed deer (Odocoileus virginianus) from Fauquier County, Virginia, USA, based on histopathology and culture for Mycobacterium avium subspecies paratuberculosis. Clinical and pathologic findings included emaciation; loss of body fat; chronic diarrhea; severe, chronic, diffuse granulomatous colitis with intrahistiocytic acid-fast bacilli; moderate, chronic granulomatous lymphadenitis with intrahistiocytic acid-fast bacilli; as well as moderate chronic, multifocal, lymphoplasmacytic hepatitis. These findings are consistent with previous reports of Johne's disease in cervids. Subsequent targeted surveillance of 10 emaciated deer with diarrhea, as well as sampling of 72 asymptomatic deer for M. avium subsp. paratuberculosis using culture of multiple tissue types, as well as serology using an enzyme-linked immunosorbent assay (ELISA) optimized for cervid antibody detection, did not reveal any additional cases of infection in this geographic region. To date, this appears to be an isolated case of Johne's disease in a free-ranging white-tailed deer, and infection with the causative agent for Johne's disease appears to be an infrequent occurrence in deer from this region. The origin of infection was most likely domestic ruminants. This is the first report of clinical Johne's disease in a free-ranging white-tailed deer outside of the Florida Keys, USA. Stressors, such as high deer population density and low selenium levels, may have contributed to the development of clinical disease in this case and warrant further investigation.

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.

Chronic granulomatous lymphadenitis in visceral leishmaniasis

Chronic granulomatous lymphadenitis in visceral leishmaniasis D.W. Bell, D.W. Bell Lt.-Col. Search for other works by this author on: Oxford Academic PubMed Google Scholar J.A.G. Carmichael, J.A.G. Carmichael Lt.-Col. Search for other works by this author on: Oxford Academic PubMed Google Scholar P.D. Stewart P.D. Stewart Lt.-Col. Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 51, Issue 4, July 1957, Page 289, https://doi.org/10.1016/0035-9203(57)90090-1 Published: 01 July 1957