Cervical Node Enlargement Research Articles

Remission of late-onset post-heart transplantation lymphoproliferative disorder following treatment with rituximab and modified mini-CHOP chemotherapy: A case report.

Post-transplant lymphoproliferative disorder (PTLD) is one of the most frequent secondary malignancies that can follow immunosuppressive therapy for solid organ transplantation, and may result in severe morbidities and even mortality. A middle-aged Han Chinese patient, prescribed with immunosuppressive cyclosporine and prednisone, developed PTLD that manifested as a painless cervical lymph node enlargement, 12 years following heart transplantation. Histology revealed monomorphic B-cell PTLD (diffuse large-cell lymphoma); as a result the immunosuppressive regimen of the patient was changed to tacrolimus and mycophenolate mofetil. In addition, the patient was changed to 6-cycle rituximab with a modified mini-CHOP (R-mini-CHOP) regimen for induction, and 8-cycle quarterly rituximab treatment and maintenance therapy. R-mini-CHOP therapy was well tolerated, and no allograft rejection occurred. The patient exhibited clinical remission as demonstrated by the results of the positron emission tomography-computed tomography at the 5-year follow-up visit following R-mini-CHOP therapy. In conclusion, R-mini-CHOP therapy following reduced immunosuppression is effective and safe for the treatment of late-onset PTLD following heart transplantation.

Eyelid Swelling and Proptosis with Systemic Implications

PRESENTATION A 20-year-old woman presented with a 4-day history of left upper eyelid swelling with erythema and tenderness (Figure 1). Two months prior to presentation, she had a similar episode on the left side, which was diagnosed at an outside facility as a chalazion with associated preseptal cellulitis. Her symptoms resolved with 4 days of oral cephalexin. One month later, she developed similar symptoms on the right side. She was again diagnosed with preseptal cellulitis in the setting of a chalazion, and her symptoms resolved with 7 days of oral cephalexin. Her review of systems was positive for 3-4 years of intermittent joint swelling and pain. Initially, small joints, but recently also medium joints, were involved. The pain and swelling would occur in 1-2 joints for 1-2 weeks and then shift to another 1-2 joints. In addition, she noticed several enlarged cervical and axillary lymph nodes for the past 2 years. She also had dry mouth in the morning, but no significant dry eye symptoms. She noted no fever, chills, night sweats, or weight loss, but had chronic fatigue for 2 months. She also had mild chronic facial erythema that did not worsen with sun exposure. Her family history was notable for her mother having been affected by an unspecified connective tissue disease. On ophthalmologic examination, her visual acuity was 20/20 in both eyes, with normal color vision. Her pupils were normal, with no relative afferent pupillary defect. Her intraocular pressure was normal. She was orthophoric and had no subjective double vision. Right extraocular movements were full, but her left eye showed mildly limited abduction and supraduction. Her confrontation visual fields

Clinical Characteristics of Severe Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) in Children

To analyze the clinical characteristics of children with Kikuchi-Fujimoto disease focusing on cases with prolonged fever. This was a retrospective study of children diagnosed with Kikuchi-Fujimoto disease from March 2003 to February 2015 in South Korea. Electronic medical records were searched for clinical and laboratory manifestations. Among 86 histopathologically confirmed cases, the mean age was 13.2 (SD ± 3.1) years, and male to female ratio was 1:1.32. Cervical lymph node enlargement, found in 85 of the patients (99%), was predominantly unilateral in 64 (75%), and involved the cervical lymph node level V in 67 (81%). Fever was present in 76% of the cases, with a median duration of 9 days (IQR 0.25-17.0). Multivariate analysis revealed that a high fever peak ≥ 39.0°C (P = .010) and presentation with ≥ 2 systemic symptoms other than fever (P = .027) were factors that were significantly associated with longer fever duration. As the size of the largest lymph node's short diameter increased, the fever duration increased (P = .015). Leukopenia (P = .022) also had a significant association with a longer fever duration. Patients with sonographic findings of conglomerated enlarged lymph nodes had a longer median duration of fever compared with those with separate enlarged lymph nodes (11 vs 4.5 days, P = .019). Patients with high fever, more systemic symptoms, leukopenia, and larger lymph nodes with a conglomerated distribution may benefit from early recognition and selective consideration of corticosteroid therapy.

The significance of enlarged cervical lymph nodes in diagnosing thyroid cancer.

We aim to investigate the significance of enlarged cervical lymph nodes (ECLN) identified by initial surgeon-performed ultrasound (US) as a tool for determining the risk of malignancy in the patients presenting with suspicious thyroid nodules. Radiological and surgical reports were retrospectively reviewed for the patients with suspicious thyroid nodules who underwent thyroidectomy and preoperative comprehensive neck US. Ultrasonographic features of the identified cervical lymph nodes were correlated with the final pathology report. Patients with malignancy other than papillary thyroid cancer (PTC) were excluded. The study consisted of 440 patients. On final pathology, PTC was found in 142 patients (32.3%), the remaining 298 (67.7%) exhibited benign findings. ECLN (>1 cm) were found in 66 (46.5%) patient with PTC compared to only 53 (17.8%) patients with benign nodules (P < 0.001). Of the 119 patients with ECLN, 54.6% had benign appearing ECLN with no suspicious features, 26.1% had one suspicious feature, and 19.3% had more than one suspicious features. Benign appearing ECLN had a positive predictive value (PPV) of 41.54%, negative predictive value (NPV) of 59.02%, sensitivity of 51.92%, and specificity of 48.65% in predicting malignancy as opposed to the absence of ECLN. While as opposed to benign looking ECLN, ECLN with only one suspicious feature had a PPV of 70.97%, NPV of 50.00%, sensitivity of 33.33%, and specificity of 83.02%, and ECLN with two or more suspicious feature had a PPV of 73.91%, NPV of 48.96%, sensitivity of 25.76%, and specificity of 88.68%. ECLN are associated with an increased likelihood of thyroid malignancy in the patients undergoing evaluation of a suspicious nodule. The risk of malignancy in thyroid nodules increases with the presence of suspicious ultrasonographic features on cervical lymph nodes.

Cytological Study of Cervical Lymphadenopathy in a Trtiary Care Institution from Kashmir Valley, India

Background: Cervical lymphadenopathy is a common clinical finding in all age-groups that ranges in etiology from inflammation to malignancy. Fine needle aspiration cytology (FNAC) is a standard first-line investigation in the evaluation of cervical lymphadenopathy. Objective: The study aimed to analyze the clinical profile and causes of cervical lymphadenopathy in different age-groups and the diagnostic utility of FNAC in our setup. Methods: This retrospective study included all the patients of cervical lymphadenopathy of more than 2-3 weeks duration, who underwent FNAC in our tertiary care institution in Kashmir valley, India during the two-year study period (January 2009-December 2011) in whom the aspirated material was adequate and satisfactory for evaluation. Results: A total of 790 patients were selected. Upper deep cervical lymph nodes were involved most frequently (38.9%); reactive lymphadenitis (39.4%) followed by metastasis (38.2%) were the commonest causes, in general. In addition, reactive lymphadenitis was the most common cause of lymphadenopathy in all age groups less than 40 years and at all topographic sites of cervical lymph node. However, in more than 40 years age-groups and at supraclavicular region, metastasis was the commonest cause of enlargement. Squamous cell carcinoma (36.4%) followed by adenocarcinoma, (25.8%) were the most common metastatic tumors. Conclusion: Enlargement of cervical lymph nodes, particularly in elderly patients involving supraclavicular nodes, should raise a suspicion of malignancy; and cervical lymphadenopathy can be effectively evaluated by FNAC without the need for surgical biopsy.

Pulmonary Hydatid Cyst in a 13 Years Old Child: A Case Report

Hydatid disease is caused by genus Echinococcus, it's transmitted to human through sheep and cattle. People who lived in an endemic area should be suspected to have the disease. Pulmonary hydatid disease can be presented by respiratory manifestations as in our case. We report a case of a child, 13 years old, who was presented by shortness of breath and non-productive cough 2 months ago. The patient had an attack of hemoptysis 3 months ago but there is no history of fever, other constitutional symptoms or any medical illness. The patient had a close contact with horse. On examination, the patient was oriented and vitally stable. Both sides of the chest were moving equally with decreased air entry on the left side of the chest. Cervical lymph node enlargement was also detected. The case was provisionally diagnosed as tuberculosis. The x-ray was normal, while CT scan showed two cysts on the left side. The patient was treated surgically with resection of both cysts without lobectomy. Bronchoalveolar lavage was done and together with plural effusion and both cysts were sent for histopathology. The patient received the following medication: Albendazole 200 MG/BID/Orally for 30 days and Cefuroxime 250 MG/Q12H/ Orally for 10 days.

Estimation of thyroglobulin in lymph node aspirates: Pilot experience from a tertiary referral cancer center.

Background:Assessment of cervical lymph node involvement in patients with thyroid cancer either during preoperative surgical mapping or detection of recurrences during follow-up is a crucial step in the management of differentiated thyroid cancers (DTCs). In most patients, fine needle aspiration cytology (FNAC) confirms the presence of metastasis in lymph node. However, in cases of paucicellular lymph node aspirate or discordant sonogram and cytology results, thyroglobulin (Tg) measurement in the lymph node aspirate (FNA-Tg) is useful and a value >1 ng/ml is considered consistent with metastatic disease.Context:The addition of FNAC to the US improves the specificity, but 5–10% are nondiagnostic and 6–8% rate of false-negative results. Several studies have reported that the detection of Tg in FNA-needle washes improves the evaluation of suspicious lymph nodes in patients with DTC.Data from Indian centers on FNA-Tg are limited.Aims:We piloted the utility of FNA-Tg in patients with sonographically suspicious cervical lymph node enlargement in the setting of suspicious thyroid nodule or in the follow-up of thyroid cancer.Settings and Design:Prospective data collection.Results:We measured Tg in 13 lymph node aspirates (12 patients, 10 females) among whom 4 patients had a total thyroidectomy and 1 had a hemithyroidectomy. Eight of the 13 lymph node aspirates had FNA-Tg values >150 ng/ml, all of them had unequivocal malignant cytology and four among them had proven metastatic DTC on surgical pathology. The median FNA-Tg of the patients with malignant cytology was 7550 ng/ml with a range of 162–30,000 ng/ml. Among the remaining 5 lymph node aspirate, 2 lymph nodes showed cytological features suggestive of reactive lymphadenitis (FNA-Tg <0.2 ng/ml) and were not operated, 1 had a high-grade malignancy consistent with anaplastic thyroid cancer (FNA-Tg <0.2 ng/ml), and 2 had nondiagnostic cytology (one had non-caseating granuloma on surgical pathology [FNA-Tg 1.3 ng/ml] and in the other patient [FNA-Tg <0.2 ng/ml] surgical intervention was deferred).Conclusions:FNA-Tg was concordant with positive cytology in all patients with DTC and may serve as a useful tool in patients with negative and nondiagnostic cytology to guide surgical management.

Clinicopathological Profile and Outcomes of Follicular Dendritic Cell Sarcoma of the Head and Neck Region - A Study of 10 Cases with Literature Review.

Follicular Dendritic Cell Sarcomas (FDCS) are rare disorders of the lymph node and soft tissues. Accurate characterization of these neoplasms is important in planning optimal treatment given its potential for recurrence and metastasis. To analyse the clinicopathological profile and outcomes of a series of 10 cases of follicular dendritic cell sarcoma arising in the head and neck region diagnosed at our regional cancer centre. A series of 10 cases of FDCS of the head and neck region from the hospital registry of head and neck cancers diagnosed between 2007 and 2013 were collected and analysed retrospectively. Clinical details, pathologic features, immuno-phenotypic profile, treatment approach and outcomes over a period of 5 years were noted. The Recurrence Free Survivals (RFS) of all the patients were recorded. The median age of the patients was 57 years and the mean age was 50.9 years. Male: female ratio was 7:3. In eight of the 10 patients, the tumours were located in the tonsils. All the tumour cells showed diffuse cytoplasmic CD21 and CD23 positivity by IHC. All the 10 cases underwent surgical excision of the tumour and three cases underwent additional neck dissection for cervical lymph node enlargement. All the patients with high grade tumours were uniformly managed with Tri-modality treatment (Surgery followed by radiotherapy and chemotherapy). The overall recurrence rate was 70%. The mean and median recurrence free survival was 39.6 and 44 months, respectively. Two of the three patients who remained recurrence free at the end of the 60 months had low grade tumours. Early recognition of follicular dendritic cell sarcomas requires a high index of suspicion and bi-modality or tri-modality treatment may cure a subset of low and high grade tumours respectively and prolong recurrence in a large subset of patients. Surgery is the mainstay and the definitive modality of treatment; the advantages and benefit of adjuvant radiotherapy and chemotherapy are yet to be established. Tri-modality management may have a role in high grade patients which needs to be substantiated in future studies.

Aspergillus Lymphadenitis Mimicking Cervical Lymph Node Recurrence in a Breast Cancer Patient

Invasive aspergillosis mostly occurs in severely immune compromised patient and infrequently in an immunecompetent host. The usual site of infection is the pulmonary system. Extra pulmonary sites such as isolated lymphadenopathy without systemic symptoms are rare. We present a case of aspergillosis in the cervical lymph node of breast cancer patient six years after completing chemotherapy. Diagnosis was excision biopsy of an enlarged cervical lymph node and the patient was successfully treated with oral Itraconazole for three months without disease recurrence 3 years following completion of medication.

Application of contrast-enhanced ultrasound in differential diagnosis of cervical lymph nodes

Objective To evaluate the ability of contrast-enhanced ultrasonography (CEUS) in differentiate reactive lymph node, metastatic lymph node and lymphoma. Methods In a prospective study CEUS was performed in 129 patients with cervical lymph node enlargement. The entire process were recorded and preserved in DICOM format. The results were registered with Sonoliver. The receiver operating characteristic curve (ROC curve) analysis was performed to find the corresponding cutoff values. The selected node was removed surgically and submitted for histology. Results Of all the nodes, 26 were reactive nodes, 85 were metastases and 18 were lymphoma. Enhancement pattern was the most accurate way to characterize lymph nodes. The enhancement pattern of reactive lymph nodes was homogeneous and most of them were enhanced by lymphatic type while the metastatic lymph nodes were inhomogeneously enhanced or weakly enhanced by peripheral type. Lymph node lymphoma usually had no fixed enhancement pattern.Arrive time (AT), rise time (RT), time to peak (TTP), mean transit time (mTT), maximum intensity(IMAX), under the curve (AUC), rising slope(Kup), semi descending slope(Kdown) and perfusion index (PI) were significantly different in the three groups(P 0.05). When TTP≥7.74 s, mTT≥26.54 s, metastatic lymph nodes were considered. When RT≥4.62 s, TTP≥7.74 s, mTT≥28.32 s, reactive lymph nodes were not considered. Conclusions Dynamic contrast-enhanced ultrasound image and enhancement pattern can distinguish neck lymph nodes while the optimal cut-off point time of the time-intensity curve parameters can further contribute to the identification of lymph nodes. Key words: Contrast-enhanced ultrasound; Lymph nodes; Diagnosis, differential

Metastasizing Ameloblastoma

A 27-year-old man presented with an 8 cm diameter left maxillary mass and an enlarged cervical lymph node at levels II to III. There was a reported history of a previous unspecified operation on the maxillary mass which had yielded a diagnosis of ameloblastoma. Total maxillectomy with modified radical neck dissection was subsequently performed.&#x0D; Microscopic examination of the maxillary mass shows epithelial islands and cords in a fibro-collagenous stroma. (Figure 1) The islands and cords are lined in the periphery by palisaded columnar cells with regular ovoid nuclei exhibiting reverse polarization. The nuclei are uniform with dispersed chromatin and no significant atypia. Towards the center of these islands are loosely arranged spindly to stellate cells (“stellate reticulum”). (Figure 2) Microscopic examination of the largest submitted lymph node shows an epithelial neoplasm with identical histologic features as the maxillary mass and a residual rim of lymphoid tissue at the periphery enclosed by the nodal capsule. (Figure 3) Similarly, there is neither atypia nor pleomorphism and only a few typical mitotic figures are seen in the nodal tumor. (Figure 4) These features support the diagnosis of a metastasizing ameloblastoma (MA).&#x0D; &#x0D; Metastasizing ameloblastoma is rare with only about 70 reported cases.1-5 Both the gnathic primary tumor and the metastatic foci have typical morphologies of a benign ameloblastoma with bland nuclei and absent to rare mitosis.6,7 There are no morphologic criteria that can predict this metastatic behavior. Thus, this diagnosis can only be made in retrospect upon the appearance of metastasis in a gnathic tumor that would otherwise have been diagnosed as a usual benign ameloblastoma.1-7 Suggested risk factors include rapid tumor growth, large primary tumor, delay in treatment, mandibular site, prior radiotherapy and chemotherapy.4,5 However, what is most consistent in the literature is the history of multiple recurrences and multiple surgical interventions.1,4,5&#x0D; &#x0D; The differential diagnosis is an ameloblastic carcinoma (AC). Both MA and AC are considered as the malignant counterparts of ameloblastoma.7 However AC is characterized by the presence of the usual cytologic features of a malignant neoplasm, such as nuclear pleomorphism, hyperchromasia and brisk mitotic activilty – features that are lacking in MA.6,7&#x0D; &#x0D; The literature on metastasizing ameloblastoma lists the lungs (70 to 88% of cases) and the cervical lymph nodes (15-37.8% of cases) as the most common sites of metastasis.1-5 Increased Ki-67 labeling and CD10 immunoreactivity have been reported to have significant correlation with recurrence.8,9 Whether these observations also apply to the risk of metastasis is not known due to the rarity of cases and hence the small subject populations of these studies. &#x0D; &#x0D; As the risk of metastasis cannot be predicted by morphology, long-term follow-up appears prudent in all cases of ameloblastoma, especially if characterized by recurrences and prior surgical interventions.

Ultrasonographic Findings of Cervical Lymphadenopathy with Infectious Mononucleosis

To evaluate the high-resolution and color Doppler ultrasonographic (US) characteristics of cervical lymphadenopathy in patients with infectious mononucleosis. High-resolution and color Doppler US were performed in 30 patients aged 2 to 30 years with a total of 59 palpable enlarged cervical lymph nodes due to infectious mononucleosis. The US characteristics of the nodes including shape,echotexture,hilum,border,matting,cystic necrosis,calcification and vascular pattern were assessed. Three patients received cervical lymph nodes biopsies. The common US findings of cervical lymphadenopathy due to infectious mononucleosis were round shape (69.5%),bilateral distribution (96.7%),matting (83.3%) [even bilateral matting (66.6%)],indistinct margin (79.7%),absence of hilum (66.1%),heterogeneous echotecture (61.0%),and central hilar vascular pattern(89.8%). In 2 patients with absence of the echoic hilum,lymph nodes biopsies showed histological features including marked effacement of the normal architecture in the medullary region accompanied by a mixed proliferation of lymphocytes and histiocytes. In all infectious mononucleosis nodes with a hilum,85.0% had heterogeneously hypo/iso-echoic hila and indistinct demarcation to the cortex. One of them underwent lymph node biopsy and histological findings showed obvious dilation of the sinus oidal lumen and proliferation of histiocytes. Although several ultrasonographic characteristics frequently present in the nodes of infectious mononucleosis are not specific,the combination of ultrasound findings may be valuable in differential diagnosis.

NTCT-04SPINAL CORD TOXICITY FROM INTRATHECAL CHEMOTHERAPY: A CASE WITH CLINICOPATHOLOGIC CORRELATION

We report antemortem pathologic and neuroimaging findings of severe myelotoxicity from intrathecal chemotherapy in a case of blastic plasmacytoid dendritic cell neoplasm (BPDCN) complicated by leptomeningeal disease. A 73 year old male was diagnosed with BPDCN after fine needle aspiration of an enlarged cervical lymph node. Total body PET imaging revealed extensive systemic hypermetabolic lymphadenopathy and a staging lumbar puncture was positive for malignant cells. He was treated with etoposide, vincristine, doxorubicin, cyclophosphamide, prednisone (EPOCH) and five doses of intrathecal cytosine arabinoside with the last dose administered on 2 months after diagnosis with CSF clearing. One year later, he developed progressive lower extremity weakness, numbness and bowel/bladder dysfunction. Lumbar spine imaging 4 weeks later revealed subtle linear enhancement along the cauda equina and within the dependent thecal sac, but cervical and thoracic spine MRI at this time were unremarkable. CSF showed atypical lymphoid cells and an Ommaya reservoir was placed. Intrathecal chemotherapy with methotrexate and cytarabine was started. Subsequent CSF analysis showed no malignant cells. However, the patient continued to have progressive ascending weakness and numbness, and his neurologic condition progressed to tetraplegia, low of bowel and bladder control and severe sensory loss, especially to vibration and joint position modalities. Spine MRI showed high signal intensity involving the posterior columns diffusely in the cervico-thoracic spinal cord. Metabolic and infectious work up was negative. A subsequent biopsy of the posterior columns of the lower thoracic spinal cord demonstrated cord destruction with profuse macrophage infiltration without evidence of malignant cells or microorganisms. Treatment with folate and cyanocobalamin resulted in no improvement, and the patient elected for palliative care only. This case illustrates central nervous system involvement by a rare myeloid tumor and demonstrates neuroimaging and unique antemortem pathology of intrathecal chemotherapy-induced myelotoxicity.

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.

Primary Epstein-Barr virus infection in a 40-day-old infant

Most cases of primary Epstein-Barr virus (EBV) infection during infancy and early childhood are mild or subclinical; therefore, the diagnosis of an EBV infection is not performed easily in this age group. Infectious mononucleosis (IM) is rarely reported during infancy. We report a 40-day-old infant with cervical node enlargement, cough, and coryza symptoms who was finally identified as having a case of primary IM based on the patient's clinical features and serological tests. © 2013 - IOS Press and the authors. All rights reserved.

Clinicopathological characteristics of immunoglobulin G4-related sialadenitis.

IntroductionImmunoglobulin G4-related disease (IgG4-RD) is a newly recognized fibro-inflammatory condition. Forty-two cases with immunoglobulin G4-related sialadenitis (IgG4-RS) confirmed by histopathological and immunohistochemical assessment were studied to clarify the clinicopathologic characteristics of the salivary glands involved in IgG4-RS, especially the relationship between the histopathologic features and function of salivary glands or serum levels of IgG4.MethodsClinical, serologic, imaging and histopathological data of these cases were analyzed. CT volumes of submandibular, parotid, and lacrimal glands were calculated. The saliva flow rate was measured. Scintigraphy with 99mTc-pertechnetate was undertaken in 31 cases, and the concentration index (CI) and secretion index (SI) was calculated. Relationships between fibrosis severity and salivary gland function or serum IgG4 levels were analyzed.ResultsThe first symptom was swelling of bilateral submandibular or lacrimal glands. Physical examination showed multiple bilateral major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands were enlarged in IgG4 RS. Multiple enlarged cervical lymph nodes were noted in 30 patients. Saliva flow at rest was lower than normal in 34 cases; stimulated saliva flow was lower than normal in 15 cases. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in 95.2% of cases and 78.6% patients had increased IgE levels. Serum IgG4 level was higher and saliva secretion lower as glandular fibrosis increased.ConclusionsProminent changes in the morphology, histology, immunohistochemistry and secretion of the major salivary glands of IgG4-RS patients were accompanied by involvement of the lacrimal glands and cervical lymph nodes. Elevated IgE, allergic history, eosinophil infiltration suggest allergic reactions as a potential pathogenesis of IgG4-RS. Severity of glandular fibrosis correlated with salivary function and serum levels of IgG4.

English

Background and Objectives The analysis of lymph node enlargement in the neck and predicting their clinical be haviour is not an easy task. There can often be diagnostic dilemmas as the diseases that affect the cervical lymph nodes mostly resemble each other. These diseases also include neoplastic lesions, where accurate diagnosis is the key to appropriate manageme nt. The study intends to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various modes of clinical presentation and behaviour of these conditions. Relevant investigations have also been studied. The study population consisted of patients above 12 years presenting with cervical lymph node enlargement. A proforma drafted for study of these patients was used. Patient was examined systematically giving due importance to local examination. A clinical diagnosis was arrived at and further investigations were done to confirm the diagnosis. Treatment was instituted appropriately and follow-up done. Majority of the cases in the study had non -neoplastic causes for cervical lymphadenopathy with tuberculosis being the most common. Male to female ratio of 1.22:1 noted with most cases between 12-30 years age group. Presence of clinical symptoms had limited significance. Posterior triangle group of cervical lymph nodes was most commonly affected in tuberculosis, while lymphomas predominantly showed more than one site involvement. Variable results were noted among the groups of lesions, with regard to local characteristics like size, number, laterality, mobility , caseation, involvement of other groups of lymph nodes, etc. FNAC inexpensive, quick in getting the results and easy to perform, sac essential diagnostic procedures.

Differentiated thyroid cancer in children: a series of 29 cases

To explore the best administration for the differentiated thyroid cancer in children under 14 years by reviewing of their clinical characteristics, treatment methods and results. Clinical data of 29 patients under 14 years with differentiated thyroid cancer in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between January 1998 and July 2014 were reviewed respectively. Neck mass was the chief complaint in 27 of 29 patients. Unilateral thyroid carcinoma was found in 16 cases, and bilateral in 13 cases. Solid tumor with multiple punctate calcification was observed in 21 cases (72.4%). Cervical lymph nodes enlargement was found in 24 cases (82.8%), and 15 cases (62.5%) were bilateral. Among 20 patients received primary thyroid surgery in our hospital, 18 cases presented with T2 or advanced diseases and 16 cases had cervical lymph nodes enlargement. The resection of unilateral lobe with isthmus was performed in 2 cases, and total thyroidectomy in 18 patients, including 1 case with partial trachea resection. Neck dissection was performed in 16 patients. Of 9 patients received primary thyroid surgery in other hospitals, 8 cases presented with cervical lymph node enlargement after surgery and 6 cases with pulmonary metastasis, of them 5 patients received neck dissection, 4 patients underwent resection of residual thyroid cancer plus neck dissection. Twenty-seven of all patients were treated postoperatively with 131I. All patients received follow-up, and the meaning follow-up time was 6 years and 10 months (0.5 years-16 years). No cases with death, local recurrence, and metastasis were observed in the follow-up period. Differentiated thyroid cancer is more invasive in children compared with adults. Comprehensive treatment including total thyroidectomy, neck dissection and postoperative 131I therapy may be a basic approach for the differentiated thyroid cancer in children.

Angioedema ou síndroma da veia cava superior: relato de caso

Introduction: The family doctor often sees signs and symptoms of an apparently benign nature that may turn out to be part of more severe disease. This case presents the common finding of facial edema that was interpreted as angioedema, when the underlying disease was the superior vena cava syndrome (SVCS). Case description: A 61-year-old man consulted his family doctor because of an episode of syncope. He was sent to the hospital emergency department, where vasovagal syncope was diagnosed and a microcytic hypochromic anemia was found. Subsequent investigations revealed iron deficiency anemia and a gastric antral ulcer. Three months later, he returned to the Family Health Unit with facial edema and was treated with an antihistamine. Because of persistence of his complaints, he consulted at the hospital emergency department, where angioedema was diagnosed. One month later, he was admitted to the hospital for treatment of gastrointestinal bleeding from the gastric ulcer. He later returned to the hospital emergency department with respiratory symptoms. A chest radiograph revealed enlargement of the superior mediastinum. Following admission to hospital, the diagnosis of a B-cell lymphoma was made after an incisional biopsy of an enlarged cervical lymph node. Comment: This case illustrates the diagnostic challenge presented by lymphoproliferative disorders. Distinguishing between angioedema and superior vena cava syndrome was a central challenge. Cases of diagnostic confusion between these two entities have been described in the literature. Questions related to the complexity of clinical presentations and the difficulties experienced by the family doctor in the management of this case are discussed.

The presentation of lymph nodes in Hashimoto's thyroiditis on ultrasound.

Comprehensive neck ultrasound (US) examination has become an essential component of preoperative workup for patients with thyroid cancer. Regional cervical lymph nodes may be involved in cases of Hashimoto's thyroiditis (HT). This study seeks to examine the sonographic pattern of lymph nodes in patients with HT. This is a retrospective study looking at patients with confirmed diagnoses of HT on final surgical pathology who underwent preoperative comprehensive neck US. We compared preoperative ultrasound for patients with HT to euthyroid patients with goiter. Data collected included number, size and ultrasonographic features of cervical lymph nodes. We included a total of 417 patients: 202 patients with HT in the study group, and 215 patients with goiter and euthyroid status in the control group. Patients with HT had a higher number of total cervical lymph nodes than the control group (2.00±2.35 vs. 0.76±1.36 mm; P<0.0001), most notably in cervical levels III and IV (P<0.05 for both). HT seems to be associated with an ultrasonographic pattern of increased number of enlarged cervical lymph nodes, particularly in levels III, and IV.