Enlarged Lymph Nodes Research Articles

Metastasis of primary signet ring cell carcinoma of prostate to bone marrow: A rare occurrence with review of literature

We report a case of a 65-year-old male who presented with multiple enlarged intraabdominal lymph nodes with lytic lesions over pelvic and lumbar vertebrae. His serum prostate-specific antigen (PSA) was markedly raised. Bone marrow investigation revealed the presence of diffuse infiltration of single cells having hyperchromatic nuclei, moderate amount of eosinophilic cytoplasm, and eccentrically placed nuclei resembling signet ring cells. Hence, a diagnosis of metastatic signet cell carcinoma of prostate was made on bone marrow biopsy. This variant of prostatic carcinoma is very rare and accounts for only 2.5% of all prostatic adenoacarcinomas that make our case worth reporting. To emphasize the rare occurrence of this variant, we performed a Pubmed-based literature review of 25 years.

Role of color Doppler ultrasound in differentiation between benign and malignant lymphadenopathy

Objective To evaluate the accuracy of color Doppler ultrasound in differentiation between benign and malignant enlarged lymph nodes compared with histopathological correlation. Patients and methods In all, 100 patients with lymphadenopathy in various age groups participated in this prospective study. Grayscale and color Doppler ultrasound (CDUS) was done for all of them, and then a comparison with histopathological data was done. Results Grayscale ultrasound had 88.9% sensitivity and 100% specificity with an area under the curve of 0.94 in the prediction of malignant LNs, while CDUS had 100% sensitivity and 87.8% specificity with an area under the curve of 0.93, The pulsatile index at a cutoff point >1.39 had 77.8% sensitivity and 100% specificity in the prediction of malignant LNs with an area under the curve of 0.87, while the resistive index at a cutoff point >0.69 had 78% sensitivity and 100% specificity with an area under the curve of 0.89. Conclusion Differentiation between benign and malignant lymph nodes using CDUS is a reliable and noninvasive technique.

Acalabrutinib and steroid for autoimmune thrombocytopenia due to relapsed chronic lymphocytic leukemia with severe bone marrow infiltration.

Thrombocytopenia is a frequent complication in chronic lymphocytic leukemia (CLL). Differentiating autoimmune thrombocytopenia from thrombocytopenia due to bone marrow infiltration is necessary for appropriate treatment, but sometimes difficult. Here we report a 60-year-old male patient with CLL who had achieved complete response after treatment with fludarabine, cyclophosphamide, and rituximab two years prior to presentation. He was admitted with severe thrombocytopenia that was unresponsive to intravenous immunoglobulin. Imaging studies revealed systemic enlarged lymph nodes and bone marrow aspiration was hypercellular with > 95% lymphocytes and scant megakaryocytes. Acalabrutinib 200 mg/day was administered for the treatment of CLL exacerbation. A gradual decrease in CLL cells and recovery of megakaryocytes in bone marrow were observed, but platelet counts remained low. Systemic administration of prednisolone 0.5 mg/kg, in addition to acalabrutinib, was started, considering the contribution of autoimmune thrombocytopenia; platelet recovery was rapid and sustained for more than a year. Even if bone marrow examination suggested thrombocytopenia due to direct leukemic infiltration, it is difficult to exclude the possibility of concomitant immunogenic thrombocytopenia. We conclude that for CLL patients with severe thrombocytopenia, repeating bone marrow examination and concurrent immunosuppressive therapies and treatment of the underlying CLL may be beneficial.

Tubercular lymphadenopathy for postgraduates – A minireview

Extrapulmonary tuberculosis (EPTB) remains often ignored by both medical community and authorities. This review attempts to summarize the pathogenesis, clinical presentation, investigations, diagnosis, treatment, and complication of lymph node TB (LNTB) in India. LNTB refers to Mycobacterium tuberculosis infection of the lymph nodes and is the most common form of EPTB in India. Classical symptoms include low-grade fever, weight loss, loss of appetite, night sweats, and painless enlarged lymph nodes in the neck or axilla or groin. Mediastinal lymphadenopathy presents with cough and chest discomfort and uncommonly even with shortness of breath; wherever possible, a pathological and microbiological diagnosis must be attempted by fine-needle aspiration for cytology, histopathology, acid-fast bacilli smear, and molecular tests such as cartridge-based nucleic acid amplification test and culture. For deep nodes, ultrasound/computed tomography/endobronchial ultrasound-guided aspiration can be done. LNTB is primarily requires medical management, and adjunct surgical excision is generally associated with worse outcomes. Six-month antitubercular therapy standard first-line regimen is recommended for peripheral LNTB and can be provided at the nearest local directly observed treatment short-course chemotherapy center in India.

Robot-assisted pelvic node dissection has similar operative and melanoma outcomes to open pelvic node dissection with shorter hospital stays

Background: Robot-assisted pelvic lymph node dissection (rPLND) has been employed for the surgical management of enlarged lymph nodes to reduce treatment related morbidity. With the adoption of adjuvant systemic therapy in melanoma reducing surgical indications, we set out to investigate its benefits and long-term outcomes compared to open pelvic lymph node dissection (oPLND).

Le linfoadenopatie: dalla diagnosi alla terapia

Palpable lymph nodes are a common finding in childhood. They often represent an appropriate response to local infection, particularly ear and respiratory tract infections in early childhood. However, whilst enlarged lymph nodes are predominantly benign, lymphadenopathy can represent serious underlying disease. Key features from the history and examination should allow differentiation of benign versus potentially malignant pathology.

What can hide an enlarged lymph node of a patient with prostatic adenocarcinoma?

Introduction. Adenocarcinoma is the most common prostatic malignancy where clinical management, Gleason score and recent updates in prostate cancer staging play critical role. Mantle cell lymphoma originates from malignant transformation of B lymphocyte in the outer edge of lymph node follicle, with pathognomonic overexpression of cyclin D1. We present a rare case of two neoplasms occurred in the same individual person. Case report. In a 68-year-old patient planned for radical prostatectomy during the hospital preoperative examinations using multislice computed tomography tumor mass confined to the prostate but also excessive lymph node enlargement were revealed. Tissue specimens were analyzed after using hematoxylin and eosin staining, as well as immunohistochemical biomarker panel. Having performed a thorough histological examination, a diagnosis of prostatic adenocarcinoma, Gleason score 3+4=7, ISUP GG2, was given. Microscopic analysis of lymph node involvement showed unexpected, diffuse proliferation of small lymphoid cells, with irregular nuclei, wide mantle zone and hyalinized blood vessels. After using immunohistochemical staining for specific markers, another diagnosis was set, and it was non Hodgkin mantle cell lymphoma. Conclusion. A prostatic adenocarcinoma can extremely rarely be in a coexistence with undiagnosed lymphoproliferative disease, such as non Hodgkin mantle cell lymphoma in our case.

Persistence of Granuloma or granulomatous Inflammation after Six Months of CAT-1 Anti Tuberculosis Therapy in Tubercular Lymphadenitis Patients

Background: Tuberculous Lymphadenitis is the most common form of extra-pulmonary tuberculosis. Paradoxical enlargement and new lymph nodes appearance are observed after completion of anti-tuberculous therapy. Objective: The objective of the study was to assess whether granuloma can persist in persisted or paradoxically enlarged lymph node after anti-TB treatment in tubercular lymphadenitis patient. Method: An observational cross sectional study was conducted in the Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University from March 2014 to February 2016 among patients of TB-lymphadenitis who had persistent or enlargement of previous or developed new lymph node after anti-TB therapy. History was taken; previous records were analyzed to ascertain the diagnostic basis of tuberculosis. History and physical examination were done for present status. Cytological or histopathological analysis was done at Department of Pathology, BSMMU. Result: Most of the patients were in the 21-30 years age group (Mean 25.53±7.93). Majority of them were female. Most of the respondents were student. More than half of the patients came from lower socioeconomic status. About 89% had typical symptoms of tuberculosis like fever, weight loss and loss of appetite during initial diagnosis and about one third had typical symptom of TB like fever weight loss and loss of appetite and one third had no symptoms after treatment. Majority mode of diagnostic tool was FNAC in both initial and after treatment. Majority (88.9 %) cases granuloma persisted after treatment. Conclusion: In spite of anti TB treatment with good compliance granuloma or granulomatous inflammation persisted in majority patients of persisted lymph nodes. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 216-221

Non-Tuberculous Mycobacteria with Enlarged Mediastinal Lymph Node by Next Generation Sequencing: Case Report

A young patient characterized by rapid enlargement of mediastinal lymph nodes was diagnosed as non-tuberculous mycobacterial pulmonary disease (NTM-PD) by bronchoalveolar lavage fluid Next Generation Sequencing (NGS). Laboratory examination, Chest CT scan, electronic bronchoscopy, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were performed to diagnose non-tuberculous mycobacterium pulmonary disease. Detection of bird-intracellular mycobacterium complex in bronchoalveolar lavage fluid by NGS. Chest CT scan showed multiple enlarged lymph nodes in mediastinum. 4R region TBNA: chronic granulomatous inflammation, positive bacilli were found by acid-fast staining. After the anti-NTM treatment, the symptoms of the patients were relieved. When the patient shows mediastinal lymph node enlargement of unknown cause, NTM-PD can be considered and NGS can be used to assist in the diagnosis.

Diagnostic Rate of Malignant Lymphoma Using Soluble Interleukin 2 Receptor Levels in Patients with Cervical Lymphadenopathy

Abstract Background and Objectives Cervical lymph node enlargement is observed in various diseases, including malignant lymphoma (ML). Open biopsy of the enlarged lymph node is frequently required for diagnosis, especially when ML is suspected. Serum levels of soluble interleukin 2 receptor (sIL-2R) may be useful as a biomarker of ML. This study aimed to determine whether the measurement of serum sIL-2R levels might be useful to diagnose ML. Materials and Methods We retrospectively reviewed the data of 281 patients who had undergone open cervical lymph node biopsy at our institution between 2015 and 2019, including 157 males and 124 females (age range, 5–90 years). Data on the patients' age, final diagnosis, and serum sIL-2R levels were obtained from their medical records. Results Overall, 184 cases of MLs and 97 cases of other diseases (non-MLs [NMLs]) were recorded. The mean age was significantly higher and mean serum sIL-2R levels were significantly higher in the ML group than in the NML group. In the ML group, the serum sIL-2R levels were significantly higher in patients with T cell lymphoma than in those with B cell lymphoma. The area under the receiver operating characteristic curve of the serum sIL-2R level for predicting ML was 0.711, and a serum sIL-2R level of 1,246 U/mL was associated with the maximum value of the sensitivity + specificity for the diagnosis of ML. Multivariate analysis revealed that the area under the receiver operating characteristic curve increased to 0.758 for patients aged >61 years and patients with serum sIL-2R levels of >1,246 U/mL. Conclusions Among patients presenting with cervical lymphadenopathy, the measurement of serum sIL-2R levels could be useful for distinguishing between patients with and without ML, with a cutoff level of 1,246 U/mL for the diagnosis of ML.

Castlemans Disease – Presenting with Recurrent Pleuropericardial Effusions- Mimicking Tuberculosis

Castleman disease (CD) is an uncommon heterogeneous group of lymphoproliferative disorders which can affect the lymph nodes of the neck, chest, abdomen and pelvis. It was first described by Castleman, in 1954, known as benign mediastinal lymph node hyperplasia, which was histologically similar to thymoma of unknown cause. [1] It is divided into unicentric (localized ) Castleman disease (UCD) and multicentric ( generalized) Castleman disease (MCD) based on the number of lymph nodes involved. Castleman disease has varied presentations. Clinically it can present as localized masses, or localized lymph node enlargement. Symptoms can result from compression effects of the enlarged lymph nodes and in asymptomatic patients it can be an incidental finding on radiological imaging. It can also present as diffuse lymphadenopathy with severe systemic symptoms . Rarely it presents with pleuro-pericardial effusions . We present a case of a; young gentleman presenting with anorexia, weight loss and night sweats . He had large exudative pleural effusion with pericardial effusion leading to constrictive pericarditis .He was started on ATT empirically, which was later stopped due to poor response . Extensive radiological work revealed multi loculated pleural effusion and multiple lymph nodes in the axillary and cervical area . Excisional Biopsy of the lymph nodes revealed Castleman disease .

Low Back Pain: An Unusual Presentation of Non-Hodgkin Lymphoma

Abstract Non-Hodgkin lymphoma (NHL) is a lymphoid tissue neoplasm originating from B- and T-cells and usually presents with fever, lymphadenopathy, and hepatosplenomegaly. Here is a case of NHL who presented to us with low backache. We describe a patient 63 year old female who had a known history of systemic hypertension, presented with spasmodic low back pain. On examination, she had a single right lymph node 1 cm × 2 cm palpable with spinal tenderness. Her blood reports were all within normal limits with slightly elevated inflammatory markers. Magnetic resonance imaging of the spine revealed multiple enlarged lymph nodes in the abdomen, which were compressing the celiac plexus. After a lymph node biopsy, it was revealed that she had follicular NHL. On the initiation of steroids and chemotherapy, her pain subsided. NHL has a variety of presentations. It is not necessary always fever should be a part of the presentation. Physicians should have a suspicion of lymphoma also in patients presenting with low backache.

Cytological Diagnosis of Castleman Disease by Endoscopic Ultrasound Guided Fine Needle Aspiration.

Castleman disease is a nonmalignant, lymphoproliferative disorder. Unicentric disease type involves a single enlarged lymph node or nodal regions, and multicentric disease involves multiple lymph node site involvement. We present a case of 26-year-old young female presented to outpatient with complaint of generalized weakness and abdominal pain for last 2 months. Her imaging included positron emission computed tomography which showed soft-tissue mass along the body of pancreas. Endoscopic ultrasound done showed nodal mass with extensive calcification and doppler endoscopic ultrasound showing arborising vessels. Fine needle aspiration cytology (FNAC) and biopsy taken showed lymphoid cells and diffuse hyaline material. After suboptimal response to chemotherapy regimen, she underwent open laparotomy and excision of the retroperitoneal mass.

Typical and Atypical Imaging Features of Malignant Lymphoma in the Abdomen and Mimicking Diseases.

Malignant lymphoma typically presents with homogeneous enhancement of enlarged lymph nodes without internal necrotic or cystic changes on multiphasic CT, which can be suspected without invasive diagnostic methods. However, some subtypes of malignant lymphoma show atypical imaging features, which makes diagnosis challenging for radiologists. Moreover, there are several lymphoma-mimicking diseases in current clinical practice, including leukemia, viral infections in immunocompromised patients, and primary or metastatic cancer. The ability of diagnostic processes to distinguish malignant lymphoma from mimicking diseases is necessary to establish effective management strategies for initial radiological examinations. Therefore, this study aimed to discuss the typical and atypical imaging features of malignant lymphoma as well as mimicking diseases and discuss important diagnostic clues that can help narrow down the differential diagnosis.

Spontaneous Remission in a High-Grade B-Cell Lymphoma

Case Presentation A 71-year-old lady, with a background of Rheumatoid Arthritis on methotrexate presented with fever and weight loss. Imaging revealed a liver abscess with small volume lymphadenopathy present above and below the diaphragm. She was managed with IV antibiotics and cessation of methotrexate. Interestingly the patient improved clinically however a follow-up scan 3 months later demonstrated an increase in the size of the liver lesion to 3.5 X 2.5cm as well as multiple enlarged nodes in the porta hepatis and peripancreatic areas. The concern now was for an intrahepatic cholangiocarcinoma but histology was in keeping with Diffuse Large B-Cell Lymphoma. This lesion was reviewed by numerous pathologists. Image 1 shows the core biopsy with an infiltrate of CD20+ B cells with a Ki67 of 60-70%. EBER ish was negative within the biopsy.

Clinical features of cancer with unknown primary site (clinical features, treatment, prognosis of cancer with unknown primary site)

Cancer of unknown primary site(CUPs) is a metastatic syndrome with an unidentifiable primary tumor, even after extensive workup to seek the primary site. CUPs accounts for about 3%-5% of the total number of all cancer diagnoses worldwide. The current precision medicine era has reclassified patients with CUPs into the favorable and unfavorable prognostic subset. In this study clinical characteristics and treatment of patients of CUPs were retropactively analysed. Thirty-two patients treated from July 2016 to October 2021 were included in the Affiliated Tumor Hospital of Tianjin Medical University(Tianjin, China).Common symptoms were anemia, fever, enlarged lymph nodes, abdominal pain, edema/multiple serous cavity effusion. Patients with good prognostic factors achieved good outcomes with treatment, conversely, patients with poor prognosis were generally treated empirically and had poorer outcomes. After anti-tumor treatment, the total effective rate was 41 percent(41% was the percentage of patients who achievedtumour respons). To the end of follow-up, after anti-tumor treatment, the median Overall Survival(OS) of patients was 5.4 months.

Prognostic Factors of Cervical Adenocarcinoma With Positive Pelvic Lymph Node Metastases Without Preoperative Lymph Node Enlargement Treated With Radical Hysterectomy.

Pelvic lymph node (LN) metastases are found histopathologically after radical hysterectomy (RH) in some cases of cervical adenocarcinoma with no enlarged LNs on preoperatively. The aim was to clarify whether LN metastasis is a prognostic factor in these patients, and whether any postoperative therapy is advisable. Sixty-one patients with stage I-II cervical adenocarcinoma [International Federation of Obstetrics and Gynecology (FIGO) 2008] with no enlarged pelvic LNs on preoperative imaging evaluation who underwent RH at our institution were retrospectively examined for clinicopathological, treatment, and prognosis-related factors. The median age was 47 years. FIGO stages were IB1 in 44 patients, IB2 in 10, IIA in 4, and IIB in 3. Seventeen patients (27.9%) had positive pelvic LNs. The multivariate analysis for both overall (OS) and disease-free (DFS) survival showed only pelvic LN metastasis was an independent prognostic factor. In a multivariate analysis of LN-positive cases, multiple LN metastases was an independent prognostic factor for poorer DFS. OS rates were 100%, 83.3%, and 30.0%, and DFS rates were 85.5%, 83.3%, and 12.5% for patients with no LN metastasis, single metastasis, and multiple metastases, respectively, showing a significant difference. Eight recurrences were observed in 10 patients with multiple node-positive disease, and six (75%) had an intrapelvic recurrence. Among patients who underwent RH for cervical adenocarcinoma with no preoperative enlarged LN and positive pelvic LNs confirmed postoperatively, multiple positive pelvic LNs are an independent poor prognostic factor. Because pelvic recurrence is common, concurrent chemoradiotherapy, possibly using paclitaxel and cisplatin, should be considered as adjuvant therapy.

Cytopathological Evaluation of Paediatric Non-Thyroidal Neck Swelling–Experience in a Tertiary Care Children Hospital

Background and Objective: Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with head and neck lumps. However, until recently, few reports have been obtained regarding the role of FNAC in non-thyroidal neck masses in children. Therefore, the objective of our study was to determine the diagnostic value of fine needle aspiration cytology in the diagnosis of pediatric non-thyroidal neck masses. Methods: This descriptive study was conducted at the Department of Pathology of Bangladesh Shishu (Children) Hospital & Institute January 2019 to December 2021. Hundred patients with non-thyroidal neck masses fulfilling the inclusion criteria were included in the study. Fine needle aspirations were performed, smears prepared and stained by Hematoxylin and Eosin stain. Results: The most common non-neoplastic neck swelling seen in children were an enlarged lymph node due to inflammation 38(42.2%), i.e., reactive lymphadenitis. Others were TB lymphadenitis 25 (27.8%), non-TB granulomatous lymphadenitis 2(2.22%), chronic sialadenitis 2(2.22%), branchial cyst 4(4.44%) and epidermal cyst 3(3.33%) cases. Overall sensitivity, specificity, positive predictive value and negative predictive value of FNAC in our cases are 93.06%, 72.22%, 93.06% and 72.22%. Conclusion: FNA is an important diagnostic tool in the management of childhood neck lesion with the clinical presentation. The procedure decreases the requirement for more invasive and costly procedures like surgical biopsy.

Reliability of mantoux in diagnosis of tuberculosis and factors affecting it

This study was conducted to determine the frequency of infected children cohabiting with sputum-positive and negative tuberculous adults for grounding the authenticity of the Montoux test in diagnosing tuberculosis among these groups. It was inferred from the study that a significant figure of the children with positive tuberculin skin test was not found to be diseased with tuberculosis and those with negative test results were diagnosed tuberculous based on chest X-ray, sputum examination, and FNAC of enlarged lymph nodes. Therefore, despite its widespread use, a large proportion of children remain undiagnosed yet are infected. Therefore, the Montoux test solely is not worth reliable for the diagnosis of tuberculosis and hence confirmation of the disease by more sophisticated tests is mandatory

A young patient with heart failure was diagnosed with extra-adrenal paraganglioma: a case report

BackgroundWe present a case of pelvic paraganglioma that presented with heart failure as the primary symptom.Case presentationA 35-year-old man was admitted to hospital due to heart failure. Contrast-enhanced pelvic CT showed mass shadows in the posterior wall of the bladder and multiple enlarged lymph nodes in the retroperitoneal area. Ultrasound-guided puncture was performed, and the pathologic diagnosis was extra-adrenal paraganglioma. The patient refused any chemotherapy and died within six months of diagnosis.ConclusionThe possibility of neuroendocrine-related tumors, for example paragangliomas, should be considered in young patients with heart failure, especially those with concomitant hypertension and diabetes.