Diagnosis Of Enlarged Lymph Nodes Research Articles

Artificially intelligent differential diagnosis of enlarged lymph nodes with random vector functional link network plus.

Differential diagnosis of enlarged lymph nodes (ELNs) is essential for the treatment of related patients. Though multi-modal ultrasound including B-mode, Doppler ultrasound, elastographyand contrast-enhanced ultrasound (CEUS)can enhance diagnostic performance for ELNs, the scenario of having only single or dual modal data is often encountered. In this study, an artificially intelligent diagnosis model based on the learning using privileged information was proposed to aid in differential diagnosis of ELNs in the case of single or dual modal images. In our model, B-mode, or combined with another modality, was used as the standard information (SI) and other modalities were used as the privileged information (PI). The model was constructed through the combination of the SI and PI in the training stage. By learning from the training samples, a random vector functional link network with privileged information (RVFL+) was obtained, which was used to classify the testing samples of solely the SI. Results showed that the accuracy, precision and Youden's index of the RVFL+ model, using B-mode with elastography as the SI and CEUS as the PI, reached 78.4%, 92.4% and 54.9%, increased by 14.0%, 8.4% and 24.5% compared with the model using B-mode as the SI without the PI. The method based on the LUPI can improve the diagnostic performance for ELNs.

Cell-blocks and hematolymphoid lesions.

Cell-blocks are an important component for evaluation for hematolymphoid lesions. They are especially critical for immunocharacterization of the lymphoid population especially when flow cytometry is not available or cannot be performed. In addition, cell-blocks allow various molecular pathology tests including gene rearrangement studies and FISH, proteomics analysis, and microbiology/histochemical special stains. Fine-needle aspiration (FNA) for mass lesions, lymphadenopathy, and effusion fluids are common cytopathology specimens which are frequently cell-blocked. The differential diagnosis of enlarged lymph nodes (LNs) and mass lesions is broad and includes reactive processes, granulomatous lesions and malignancies including solid tumor metastases and various types of hematological malignancies, of which lymphoma would be most common. Depending on the patient population, most lymphomas may be diagnosed with immunocharacterization on cell-block or/and flow cytometry in concert with excellent cytomorphology in Diff-Quik stained FNA aspirate smears. However, a proportion of lymphoma cases (up to 12-30%) may still require an excisional LN biopsy to evaluate architectural parameters. Similarly, various effusion fluids suspicious for lymphoma can be immunocharacterized by immunostaining of cell-block sections (or/and by flow cytometry). Availability of quantitatively and qualitatively optimum cell-blocks of specimens to be evaluated for hematolymphoid processes is critical for immunohistochemistry, polymerase chain reaction, in situ hybridization (FISH), and gene expression profiling studies.

Transverse colon invasion from intrahepatic cholangiocarcinoma with lymph node metastasis in the regional mesocolon: a case report

BackgroundIntrahepatic cholangiocarcinoma (ICC) is an aggressive cancer with high frequency of extrahepatic metastasis at diagnosis. However, there have been very few reports of direct invasion to transverse mesocolon with lymph node metastasis in the regional mesocolon.Case presentationA 71-year-old man presented to our hospital with anorexia and weight loss. Abdominal computed tomography (CT) revealed enlarged gallbladder wall with intrahepatic tumor extended from the gallbladder. The transverse colon was located adjacent to the gallbladder and its wall was thickened, indicating tumor invasion. Some enlarged lymph nodes were observed in the transverse mesocolon, suggesting metastatic or inflammatory lymph node swelling. Percutaneous liver biopsy detected poorly differentiated adenocarcinoma. After confirming the absence of remote metastasis and peritoneal dissemination, surgical resection including right hepatectomy and right hemicolectomy was performed. The pathological diagnosis was adenosquamous carcinoma of the liver and lymph node metastasis in the transverse mesocolon. The surgical margins were negative and R0 resection was achieved. Although adjuvant chemotherapy was administered, follow-up CT detected multiple metastases to the lung 4 months after surgery. The patient died 12 months after the operation.ConclusionsDirect colon invasion from ICC may cause lymph node metastasis in the regional mesocolon. Careful assessment is necessary for the diagnosis of enlarged lymph nodes in ICC with direct colon invasion.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis

Background: Tuberculosis is still a global health problem. Most common presentation of extrapulmonary tuberculosis is tuberculous lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to depend on pathological diagnosis of enlarged lymph nodes, i.e., cytomorphology with acid-fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost-effective procedure for diagnosis of various causes of lymphadenopathies.
 Objective: To determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of tuberculous lymphadenitis patients in Bangladesh.
 Materials and Methods: This cross-sectional study was done on 317 subjects in Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with icddr,b. After clinical examination, fine needle aspiration (FNA) was done. The FNA materials were processed for Papanicoulaou staining (PAP stain), Ziehl-Neelsen staining and culture for the diagnosis of tuberculosis. Sensitivity, specificity, positive and negative predictive values of FNAC were determined where culture was taken as the gold standard.
 Results: Initially 351 clinically suspected tuberculous lymphadenitis patients were enrolled, but 34 cases were excluded due to diagnosis of malignancy. Among them 123 were male and 194 were female. Mean age was 27.91±13.16 years. Among the subjects 95.9% presented with cervical lymphadenopathy, others presented with lymphadenopathy of axillary or other groups of lymph nodes. The results of cytomorphological diagnosis of TB were in 58.36% cases, and culture was positive in 23.3% cases. Sensitivity, specificity, positive predictive value and negative predictive value of cytomorphological diagnosis were 79.7%, 48.1%, 31.9% and 88.6% respectively.
 Conclusions: FNAC is an effective diagnostic method for tuberculous lymphadenitis. It can diagnose granulomatous inflammation as well as reactive and other disease conditions including malignancies, thereby providing more information about the patient’s disease status.
 J Enam Med Col 2019; 9(1): 30-33

Mediastinal silicone lymphadenopathy revealed after thymectomy for autoimmune myasthenia gravis.

Breast reconstruction is a very popular surgical intervention performed either for cosmetic reasons or after oncological resections. Even though silicone is considered to be an inert material, there are side effects that have been reported, such as silicone lymphadenopathy. In the case reported herein, a silicone lymphadenopathy of the internal mammary and the anterior mediastinal lymph nodes were revealed after a thymectomy for autoimmune myasthenia gravis. Silicone lymphadenopathy should always be part of the differential diagnosis of enlarged lymph nodes, in patients with previous cosmetic or oncoplastic surgery with the use of silicone gel breast implants. Special attention should be paid in case of previous breast cancer in order to rule out metastasis.

Mediastinal staging for non-small cell lung cancer revisited. It is being done under aegis of ICON and Lung cancer consortium asia.

Mediastinal staging is a crucial factor in the decision making in patients with non-metastatic non-small cell lung cancer (NSCLC). Mediastinoscopy has historically been the gold standard for this purpose. With the advent of PET-CT, the role of an invasive staging modality like mediastinoscopy has been diminishing. Newer developments in endoscopic staging like EBUS and EUS-FNA have also provided means to get a cytological diagnosis of enlarged lymph nodes. With the meta-analyses showing encouraging results of neoadjuvant chemotherapy in operable lung cancers including the early stage disease, the sanctity of invasive mediastinal staging for the sole purpose for selecting patients for upfront surgery is debatable. This article discusses the various modalities for mediastinal staging in NSCLC. We also present our perspective regarding the need for a balanced approach between the accuracy of mediastinal staging, invasiveness of the staging modalities, and alternate staging methods. With the liberal use of neoadjuvant chemotherapy in operable NSCLC, the role of invasive mediastinal staging procedures is likely to get limited further, giving way to non-invasive staging modalities like PET-CT.

Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist.

AIMTo evaluate factors that influence the diagnostic accuracy of endoscopic ultrasound (EUS)-guided tissue acquisition for lymph node enlargement in the absence of an on-site pathologist.METHODSA retrospective analysis of patients who underwent EUS-guided tissue acquisition for the pathological diagnosis of lymph node enlargement between April 2012 and June 2015 is reported. Tissue acquisition was performed with both cytology and biopsy needles of different calibers. The variables evaluated were lymph node location and size, number of passes and type of needle used. Final diagnosis was based on surgical histopathology or, in non-operated cases, on EUS-guided tissue acquisition and imaging assessment with a minimum clinical follow-up of 6 mo.RESULTSDuring the study period, 168 lymph nodes with a median size of 20.3 mm (range 12.5-27) were sampled from 152 patients. Ninety lymph nodes (53.6%) were located at mediastinum, and 105 (62.5%) were acquired with biopsy needles. The final diagnosis was benign/reactive origin in 87 cases (51.8%), malignant in 65 cases (38.7%), and lymphoma in 16 cases (9.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the detection of malignancy were 74.1%, 100%, 100% and 80.6%, respectively. The overall accuracy was 87.5% (95%CI: 81.7-91.7). No variables were independently associated with a correct final diagnosis according to the multivariate analysis.CONCLUSIONEUS-guided tissue acquisition is a highly accurate technique for assessing lymph node enlargement. None of the variables evaluated were associated with diagnostic accuracy.

Predictors of the necessity for lymph node biopsy of cervical lymphadenopathy.

Enlargement of cervical lymph nodes is required for early and accurate diagnosis of malignant lymphoma (ML). Lymph node biopsy is still indispensable for accurate diagnosis of lymph node enlargement in the lateral neck. We retrospectively investigated the characteristics of lymph nodes on both ultrasonography (US) and computed tomography (CT), and blood biomarkers including serum thymidine kinase (TK) and soluble interleukin-2 receptor (sIL-2R) in 19 patients who underwent cervical lymph node biopsy. Pathological diagnosis was ML in 8 patients, reactive lymphadenopathy (RL) in 8, and purulent lymphadenitis (PL) in 3. TK levels were significantly higher in patients with ML than in patients with RL, demonstrating positive correlations with sIL-2R and lymph node size on CT image. The shape of lymph nodes on US in all of the 8 patients diagnosed with RL was flat, whereas the shape in 7 of 8 patients diagnosed with ML was round. Lymph node size ≥19.5mmat an axial section on CT image was used as a cut-off value to differentiate ML from other pathologies, offering 90.9% sensitivity and 87.5% specificity. Sonographic and CT evaluation combined with high TK level might be useful in determining the need for early biopsy.

Study of Incidence and Cytomorphological Patterns of Tubercular Lymphadenitis in a Secondary Care Level Hospital of Jammu Region

Background: Tuberculosis is still a global health concern. Most common presentation of extra pulmonary tuberculosis is tubercular lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to rely on pathological diagnosis of enlarged lymph nodes i.e. cytomorphology with acid fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost effective procedure for diagnosis of various causes of lymphadenopathies. Our study is the first one in its type in J&K reporting the incidence and pattern of Tubercular Lymphadenitis in secondary level health care hospital. Aims: To report the incidence and describe various cytomorphological patterns of tubercular lymphadenitis in secondary care level Government Hospital, Gandhi Nagar, Jammu. Material and Methods: In a study period of two and a half years, two hundred and thirty one consecutive enlarged lymph nodes were aspirated and subjected to cytomorphological evaluation with Papanicolaou(PAP), Giemsa ,and Ziehl- Neelsen (Z-N) stained smears. Results: Incidence of tubercular lymphadenitis was reported as 34.6% (C.I 0.285-0.411). Around 80% of cases were in the second to fourth decades of life with mean age as 27.08 years and male to female ratio of 1:1.6 .Cervical region was the most common site of involvement with multiple unilateral lymphadenopathy as the most common presentation. The most common cytological picture was epithelioid granulomas with caseous necrosis (52.5%). Overall AFB positivity was seen in 65% cases. Conclusions: FNAC has proved as a very useful first line of investigation in patients presenting with lymphadenopathy, especially in secondary care centres. Key words: Cytomorphological patterns, FNAC, Incidence, Secondary level Hospital, Tubercular lymphadenitis, Z-N staining.

Sensitivity of EUS and ERCP Endoscopic Procedures in the Detection of Pancreatic Cancer During Preoperative Staging Correlated with CT and CT Angiography Imaging Methods.

The goal:The goal of this work was to give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA.Material and Methods:The study included 49 patients, 20 women and 29 men hospitalized at the Clinic for gastroenterohepatology, due to suspicion on pancreatic cancer during observed 2 years period. All cancers were histologically and cytologically confirmed. The patients underwent ERCP as a mandatory part of staging and all patients underwent endoscopic ultrasound as well as CT or CT angiography.Results:Testing of differences was carried out using Fisher’s exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2–1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75–1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27–3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2–1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA.Conclusion:EUS as endoscopic method compared to CT and CTA is one of the more invasive methods of examination but due to its ability to be performed immediately, to locate a changes smaller than 5 mm and the target biopsy option, to measure the change and that in many cases determine the relationship of malignant lesions with blood vessels, along with visualization of the surrounding lymph nodes and metastases in neighboring organs, we may give this method an advantage over other methods in the preoperative staging of patients with pancreatic cancer.

Spectrum of Extra pulmonary Tuberculosis in Oral and MaxilloFacial Clinic: Two Distinct Varieties

Extrapulmonary tuberculosis is on the increase world over. Tuberculous Lymphadenitis is the commonest form of extrapulmonary tuberculosis. The focus of Tuberculosis(TB) control programme has been on the pulmonary variety , because that is the cause of lot of misory and ill health. Tuberculos cervical lymphadenitis , or scrofula is one of the most common extra-pulmonary manifestations of tuberculosis. Diagnosis of enlarged lymphnode is challenging. A calcified lymph node is indicative of a prior chronic infection involving the node. This paper is to highlight two distinct variety of extrapulmonary tuberculosis.

韦氏环及鼻腔Rosai-Dorfman病放射治疗一例报告

Rosai-Dorfman病(Rosai-Dorfman disease, RDD)是一种原因不明、少见的良性组织细胞增生性疾病，主要表现为无痛性双侧颈部淋巴结肿大，少数可发生在淋巴结外组织。由于RDD没有特征性临床及影像学表现，因此容易被误诊。迄今，该病尚无统一的治疗意见，多数预后良好。本文报道一例韦氏环及鼻腔RDD，分享放疗治疗RDD的经验，并借此讨论韦氏环淋巴结肿大的鉴别诊断。 Rosai-Dorfman disease is a rare unknown proliferative disease of the benign tissue cell, with a main symptom of painless bilateral cervical lymph node enlargement, and fewer occurrences may be diagnosed in peripheral lymph nodes. Since Rosai-Dorfman disease displays no characteristic clinical and imaging features, it is more liable to be misdiagnosed. There is not a unified treatment of the disease so far; however, the prognosis of most of the patients is good. This paper reports a case of Waldeyer’s ring and nasal Rosai-Dorfman disease that has achieved good results by radiotherapy, aiming to emphasize the differential diagnosis of lymph node enlargement of Waldeyer’s ring.

A Case Report of Kikuchi-Fujimoto Disease with Immune Thrombocytopenic Purpura

1 Department of Pathology, Severance Hospital, Seoul, Korea Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is a rare disease characterized by lymphadenitis with fever. It is self-limited within one to four months, and is generally diagnosed by an excisional biopsy of the affected lymph node. Kikuchi-Fujimoto disease has a wide variety of nonspecifi c symptoms and it is sometimes misdiagnosed as malignant lymphoma, lymph node tuberculosis, or systemic lupus erythematosus. Because clinical course and treatment of this disease differ from those of others, Kikuchi-Fujimoto disease must be included in differential diagnosis of enlarged lymph node. In this report, we discribed a case of 24-year-old male patient who visited the clinic complaining of fever, petechiae, and enlarged lymph node. He was diagnosed as Kikuchi-Fujimoto disease and immune thrombocytopenic purpura.

A suspected [18F]fluorodeoxyglucose positron emission tomography-negative metastatic lymph node successfully diagnosed by laparoscopic staging in esophageal cancer: Report of two cases

An accurate preoperative staging is important for selecting an appropriate therapy for esophageal cancer. In particular, diagnosis of lymph node metastases influences the indication for radical surgery. [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely applied primarily as a useful tool for initial staging of esophageal cancer. However, false-negative cases sometimes make it difficult to select the appropriate treatment. We report two patients with esophageal cancer and PET-negative enlarged lymph node successfully diagnosed by laparoscopic sampling. This procedure did not only allow accurate histopathological staging, but also helped to select the optimal minimally invasive management. This technique can be recommended for patients with esophageal cancer in whom the diagnosis of enlarged lymph node cannot be confirmed by preoperative imaging.

Dermatopathic lymphadenopathy: a differential diagnosis of enlarged lymph nodes in uremic pruritus

In end-stage renal disease patients, the incidence of both infections and malignancies is increased leading to a higher incidence of peripheral lymphadenopathy. In the present work we describe a rare but probably underdiagnosed cause for enlarged lymph nodes in uremic patients. A 43-year-old male patient was admitted to our hospital with inguinal lymphadenopathy and pruritus. He turned out to be uremic due to focal segmental glomerulosclerosis (creatinine 4.5 mg/dl, MDRD creatinine clearance 12 ml/min). Sonography revealed enlarged lymph nodes (up to 4 cm) with intact corticohilar border differentiation. After extirpation of an inguinal lymph node, histological examination established the diagnosis of dermatopathic lymphadenopathy. T cell lymphoma was excluded by PCR for T cell receptor-gamma rearrangements and subsequent GeneScan analysis. Intravenous fluid supplementation with subsequent decline of creatinine, UVB treatment, clemastine, and topical use of emollients led to a relief of the uremic pruritus and the lymph nodes' size normalized within 8 weeks. Dermatopathic lymphadenopathy refers to the reactive condition seen in lymph nodes that drain areas with disruption of the skin integrity, e.g. due to scratch marks. The present case report describes dermatopathic lymphadenopathy as a harmless cause of enlarged lymph nodes in uremic pruritus for the first time. This entity should be considered in the differential diagnosis of peripheral lymphadenopathy of unknown origin in patients with renal failure.

Enfermedad por arañazo de gato: Características clínicas y de laboratorio en pacientes adultos hospitalizados por fiebre o adenopatías

Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. To report the clinical and laboratory features of eight patients with cat-scratch disease. Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

Fine needle aspiration cytology of enlarged lymph nodes in children and adolescents

Purpose:Palpable lymph nodes are common in the pediatric population, and most of them are either inflammatory or congenital. As the diagnostic evaluation, fine needle aspiration cytology (FNAC) is known to be more convenient and economical than tissue biopsy. We evaluated the usefulness of FNAC in children and adolescents. Methods:Four hundred and thirteen FNAC samples(M:F=1:1.15) were retrospectively analyzed in patients who were brought to Inha University Hospital, from August 1999 to August 2004. Results:The most common age group was 16-20 years of age(N=148, 35.8 percent). The cervical area was the most frequently involved site(N=310, 75 percent). Non-specific lymphadenitis was the most common(N=227, 54.9 percent), followed by the benign neoplasm(N=59, 14.2 percent). Malignant tumors were 18 cases(4.3 percent), and congenital diseases were found in 10 cases(2.4 percent). In inflammatory lesions, tuberculous lymphadenitis(N=22, 5.3 percent) was the most common with a histologic sensitivity of 90.9 percent. The peripheral blood and serologic studies were non-specific. Fifty nine percent(N=244) of lymphadenitis improved without specific management. Antibiotics were prescribed in 15.2 percent of lymphadenitis and lymphadenectomy was performed in 12.6 percent. Conclusion:Most of the enlarged lymph nodes in children and adolescents were benign. These results show FNAC is a safe, rapid and reliable diagnostic procedure for the appropriate differential diagnosis of enlarged lymph nodes in children and adolescents.

Ultrasound-Guided Transbronchial Needle Aspiration : An Experience in 242 Patients

Conventional transbronchial needle aspiration (TBNA) is a valuable procedure but remains underutilized. Recently, imaging guidance such as CT fluoroscopy has created considerable interest. As CT fluoroscopy is cumbersome and exposes patients and staff to radiation, we have examined the feasibility of endobronchial ultrasound (EBUS) in providing imaging support for TBNA. Prospective consecutive patient enrollment. University-related tertiary referral centers for pulmonary diseases. From January 1999 to January 2000, 242 consecutive patients were entered into this prospective study (82 women and 160 men; mean age, 60.0 years). Indications for TBNA were diagnosis of enlarged lymph nodes and cancer staging. The average lymph node size was 1.7 cm (SD, 0.47; range, 0.8 to 4.3 cm). Target lymph nodes were visualized with EBUS, followed by TBNA in standard fashion. All targets could be visualized with EBUS. In 207 patients, the lymph nodes were successfully sampled (86%). This was independent of lymph node size and location. A firm diagnosis or cancer stage could be obtained in 172 patients (72%). There were no complications associated with the use of EBUS. EBUS is simply performed and if used for TBNA guidance affords an excellent yield independent of lymph node location. Randomized trials comparing standard TBNA and imaging-guided TBNA by CT fluoroscopy and EBUS are indicated.

Surgical management of severe common carotid artery injury after mediastinoscopy

Mediastinoscopy is a widely used method to achieve pathologic diagnosis of enlarged lymph nodes or undefined mediastinal solid mass. Aortic arch penetration and injury of the supraaortic arteries are rare but very dangerous complications of mediastinoscopy. We describe the hazardous transportation of a 57-year-old woman after mediastinoscopic injury of the right common carotid artery and its successful repair with cardiopulmonary bypass and deep hypothermia.