Cervical Group Of Lymph Nodes Research Articles

Cytomorphological Analysis of Lymph Node Lesions in HIV-Positive Patients with CD4 Count Correlation: A Cross-Sectional Study

Objectives: To study the cytomorphological spectrum of lymph node lesions in HIV-positive patients and correlate the cytological findings with the CD4 count. Study Design: This was a cross-sectional study of 23 months' duration which included 110 HIV-positive cases proved according to the guidelines of the National AIDS Control Organisation. Fine-needle aspiration cytology (FNAC) was done on clinically palpable lymph nodes. Special stains and culture were done wherever necessary. CD4 count was done by flow cytometry and subsequently correlated with the cytological findings. Results: Our study included 110 cases, ranging in age from 6 to 70 years, peaking in the 3rd to 4th decade (n = 46). The male-to-female ratio was 1.75:1 and the predominant site was the cervical group of lymph nodes (n = 71). Each lesion was correlated with CD4 count, laboratory and clinical findings, and was further segregated based on WHO and CDC staging. Cytological lesions were tubercular (53.6%), reactive (27.1%), suppurative (6.4%) lymphadenitis, lymphoma (4.5%), cystic lymphoid hyperplasia (2.8%), metastases (1.9%), cryptococcal lymphadenitis (0.9%). The mean CD4 count was 217.4, 434.4, 181.4, 149, 580, 225, and 207 cells/µL, respectively. There was a highly significant correlation of cytological findings with CD4 count (χ² value = 44.57 and p < 0.001). Conclusion: FNAC is a primary, safe, and valuable tool for the identification of opportunistic infections, neoplastic and nonneoplastic lesions, as well as therapeutic modality in certain conditions. Correlation of lesions with CD4 count provides information about immune status, HIV stage and segregating cases, and also aids further evaluation and management.

Elucidation of Percutaneously Accessible Lymph Nodes in Swine: A Large Animal Model for Interventional Lymphatic Research

PurposeTo define percutaneously accessible, anatomically reproducible swine lymph nodes using magnetic resonance imaging, ultrasound, and ethiodized oil (Lipiodol; Guerbet, Bloomington, Indiana) lymphangiography. Materials and MethodsFive adult female swine (Yorkshire, 50–60 kg) were used. Under general anesthesia, T1-weighted and T2-weighted, coronal and axial images of the entire swine were obtained. The animal’s extrathoracic, extraperitoneal soft tissues from the neck to the groins were examined with ultrasound. Lymph nodes ≥ 1 cm were marked before the animal was transferred to the angiography suite. Under ultrasound guidance, the nodes were accessed, and lymphangiograms were obtained. The imaging findings between the 3 modalities were correlated, and the lymph node drainage was mapped. ResultsFour lymph nodes/lymph node groups were identified that were reproducible in all 5 animals, > 1 cm and percutaneously accessible: submandibular node, superficial cervical lymph node group, subiliac node, and superficial inguinal lymph node group. Drainage of these nodes mirrored human anatomy. The abdominopelvic lymphatics formed a retroperitoneal cisterna chyli and drained cephalad via a thoracic duct. ConclusionsThe swine exhibits reproducible lymphatic anatomy with at least 4 percutaneously accessible lymph nodes/lymph node groups. Based on these results, the swine may be a suitable large animal model for research into lymphatic interventions.

An insight on pediatric peripheral Lymphadenopathy: Atwo year cytological study in a tertiary care hospital

Introduction & Objective: Lymphadenopathy in pediatric population is an ever challenging situation. This study was done to study the cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by fine needle aspiration cytology (FNAC) and determine the pattern of diseases affecting the children below 18 years.Materials and Methods: 453 cases between the age group of 0-18 years, referred to the cytology section of the department of Pathology were included in the study over a period of two years. Special stains and biopsy were done in selected cases. Results: Majority of the cases were benign (97.60%), while only 2.4% (13/543 cases) of cases were malignant. Reactive hyperplasia, tuberculous lymphadenitis, suppurative lymphadenitis, metastatic carcinoma and lymphoma were seen in 53.2%, 30.20%, 10.68%, 0.2% and 1.8% respectively. Cervical group of lymph nodes were the most frequently affected nodes. In 37 cases, the cytological diagnosis was compared with histopathological diagnosis.Conclusion: The most frequent cause for lymphadenopathy in pediatric population is reactive hyperplasia followed by tuberculosis.FNAC alone can be useful in establishing diagnosis in large number of cases in proper clinical setting and obviates the need for invasive procedures like surgery. Introduction & Objective: Lymphadenopathy in pediatric population is an ever challenging situation. This study was done to study the cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by fine needle aspiration cytology (FNAC) and determine the pattern of diseases affecting the children below 18 years. Materials and Methods: 453 cases between the age group of 0-18 years, referred to the cytology section of the department of Pathology were included in the study over a period of two years. Special stains and biopsy were done in selected cases. Results: Majority of the cases were benign (97.60%), while only 2.4% (13/543 cases) of cases were malignant. Reactive hyperplasia, tuberculous lymphadenitis, suppurative lymphadenitis, metastatic carcinoma and lymphoma were seen in 53.2%, 30.20%, 10.68%, 0.2% and 1.8% respectively. Cervical group of lymph nodes were the most frequently affected nodes. In 37 cases, the cytological diagnosis was compared with histopathological diagnosis. Conclusion: The most frequent cause for lymphadenopathy in pediatric population is reactive hyperplasia followed by tuberculosis.FNAC alone can be useful in establishing diagnosis in large number of cases in proper clinical setting and obviates the need for invasive procedures like surgery. Normal 0 false false false EN-IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Evaluation of pathologic lesions in superficial lymph node biopsies

Introduction: Lymphadenopathy can be due to any disease process involving lymph nodes. Enlargement of lymph node is a very common clinical symptom seen in outpatient department of any hospital. Lymphadenopathy can occur at any age group and at any site of the body. Detail clinical history for signs and symptoms, size of lymph nodes, presence of generalized lymphadenopathy, and hepatosplenomegaly help to arrive at provisional diagnosis. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping of lymphomas. Aim: The aim of present study is to analyze pathological spectrum of various neoplastic and non-neoplastic lesions affecting superficial lymph nodes in the neck, axilla, inguinal region and correlation with clinical findings. Materials and Methods: The present study was a retrospective study conducted in the department of Pathology, at Chalmeda Anand Rao Institute of Medical Sciences, Bommakal Karimnagar,during the period from february 2014 to march 2015. Lymph node biopsies of all patients of both sexes and all age groups were included. Total 47 lymph node biopsies were selected for histopathological evaluation which constituted the study material. Among these 25 were from males and 22 were from females with male to female ratio being 1.2:1. The age of the patients ranged from 3 to 71 years with a mean age of 40-49 years. Results: Out of total 47 cases, 15(31.9%) cases were tuberculous lymphadenitis ,13 cases (27.6%) were malignant lymphoma while metastasis was found in 10(21.2%) cases, reactive hyperplasia in 5(10.6%) cases, suppurative lymphadenitis in 2(4.2%) cases, castleman disease and kikuchi disease, the least common condition was seen in only one case(2.1%) each. Cervical lymph nodes were most commonly biopsied group of lymph nodes in our study. Conclusion: Tuberculosis was the most common cause of lymphadenopathy, followed by malignant lymphoma and the cervical group of lymph nodes was most frequently affected.

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.

Prevalence and Clinical Characteristics of Primary Epstein-Barr Virus Infection Among Children Presented with Cervical Lymphadenopathy.

Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infection is not sought as a cause in low-resources settings. The virus among children with cervical lymphadenopathy was not studied before in this country. The aims of this study were to estimate the prevalence of primary EBV infection and to describe clinical characteristics of children presenting with cervical lymphadenopathy. A cross-sectional study was conducted among children presented with cervical lymphadenopathy to Khartoum Children Emergency Hospital during the period from February 2009 to January 2010. Eighty-two children were randomly selected. Demographic and clinical data were recorded. Routine laboratory values were determined and children's sera were analysed for anti- viral capsid antigens IgM Epstein-Barr virus ELISA tests. Mean and SD were calculated. Regression analysis was to identify association between demographic, clinical and laboratory variables and IgM seropositivity of EBV. Epstein-Barr virus infection was diagnosed in 13 (15.9%) children with cervical adenopathy (n=82). The average age of these children was 7.5 (SD±3.3) years. The male to female ratio was 1.6. The most frequent symptoms were fever, loss of appetite and cough. The anterior cervical group of lymph nodes was most commonly implicated. All affected patients had mobile lymph nodes and the majority, 12 (92.3%), of patient had firm nodes. The lymph node number ranged from 2-6 nodes; with a mean of 3.5 nodes and average size of 3.6 cm. Splenomegaly and pharyngo-tonsillitis were found in 30.8% and 23.1% of patients respectively and leukocytosis was noted in 3 (23.1%). The odds of IgM seropositivity decreased with age ≤ 9 years (OR 0.15, 95% CI 0.03-0.78, p=0.023). EBV infection is not an uncommon cause of childhood cervical lymphadenopathy. The commonest symptoms are fever, loss of appetite and cough. Anterior cervical nodes are the most affected. Younger children (age ≤ 9 years) are less likely to be sero-positive.

Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes.

The aim of the current study is to determine the efficacy of ultrasound in differentiating between benign and metastatic group of cervical lymph nodes. The study included forty-five subjects who were divided into three groups with 15 in each, by stratified random sampling method. Group 1 comprised fifteen patients without signs and symptoms of any infection and neoplasms in head and neck region (control group). Group 2 included fifteen patients with signs and symptoms of malignancy in head and neck region. Group 3 consisted of fifteen patients with signs and symptoms of odontogenic infections. “MY LAB-40” ultrasound machine with linear array transducer of 7.5 MHZ frequency was used for detecting cervical lymph nodes following Hajek's classification. The patients further underwent ultrasound guided FNAC under standard aseptic protocol and samples were subjected to cytopathological evaluation. Chi square analysis and one way ANOVA test were applied to obtain the results. We concluded that ultrasound and USG FNAC can be used accurately to assess the status of lymph nodes. The ultrasonographic features of lymph nodes with round shape, absence of hilar echo, sharp nodal borders, hyperechoic internal echogenicity, and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes.

Pattern of tuberculosis lymphadenitis diagnosed by fine needle aspiration cytology in Gondar University Hospital

<h3>Introduction</h3> Tuberculosis lymphadenitis is the most common extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) provides a cheap and rapid diagnostic means in resource poor setting. <h3>Objectives</h3> The purpose of this study is to assess the pattern of tuberculosis lymphadenitis in Gondar university hospital. Prevalence, age, sex and site distribution is determined in this study. <h3>Method</h3> This is a retrospective descriptive study conducted by reviewing FNAC record done in one year in Gondar university hospital. <h3>Result</h3> There was a total of 1884 patients on whom FNAC was done in the pathology department over period of one year. Of these, 600 (32%) were LN aspirates. Of these 600 cases, 321 (53%) showed cytological features of tuberculosis lymphadenitis. Females accounted for 55% of patients with the diagnosis of tuberculosis lymphadenitis. Patients' ages ranged from 3 to 78 years. The most commonly involved lymph nodes were the cervical group of lymph nodes (46%). Two were from intra-abdominal lymph nodes. <h3>Conclusion</h3> Prevalence of tuberculosis lymphadenitis is high in Gondar. Immediate public health measures to treat, prevent and control this disease should be put in action as soon as possible.

Papillary carcinoma of thyroid with an unusual coexistence of metastatic deposits and tuberculosis in the cervical lymph nodes

Papillary carcinoma of the thyroid with clinically significant cervical lymphadenopathy is a common presentation (particularly in young patients), and it may be the first manifestation of disease. Occasionally, besides metastatic deposits, the cervical lymph nodes may harbor other diseases, and determining the etiology in such a case becomes critical for the institution of proper treatment and complete cure of the patient. Detection of tuberculous lymphadenitis and metastatic deposits by radiological and/or fine needle aspiration cytology methods may not be always easy and may be missed due to inherent defects of the techniques hence, histopathological examination still remains the final resort. We report a case of papillary carcinoma of the thyroid and its rare association with both metastatic deposits and tuberculosis of the contiguous cervical lymph node groups. We suggest that tuberculosis must always be borne in mind besides metastases while evaluating the enlarged neck nodes in papillary carcinoma of the thyroid.

Histopathological Evaluation of Lymph Node Biopsies: A Hospital Based Study

Background: Lymphadenopathy is a common manifestation of a large variety of disorders,both benign and malignant. It is essential to define the pattern of disorders presenting primarily as lymph node enlargement in a particular environment. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping oflymphomas. We designed this study in our population for histopathological evaluation of lymph nodes that might be helpful for clinical management of these lesions. Objective: Histopathological evaluation of lymphadenopathy from excised specimen, in relation to ageand sex of the patients, and distribution of the lymph nodes. Materials and Methods: It was a retrospective cross sectional study conducted in the department of Pathology, Enam MedicalCollege &amp; Hospital, Savar, Dhaka during the period from January 2006 to December 2010. Lymph node biopsies of all patients of both sexes and all age groups were included.Metastatic lymph nodes associated with evidence of primaries elsewhere in the body were excluded from the study. Total 191 lymph node biopsies were selected for histopathological evaluation. Among these 90 (47.12%) were from males and 101 (52.88%) were from females with male to female ratio being 1:2.1. The age of the patients ranged from 2 to 85 years with a mean age of 35.73 ± 18 years. Results: Cervical lymph nodes were the most common (56%) biopsied group. Of the 191 cases 59 cases (30.89%) were reactive lymphadenitis, 64 cases (33.5%) were tuberculosis, 2 cases (1.05%) were non-caseous granuloma, 11 cases (5.76%) were Hodgkin lymphoma, 22 cases (11.52%) were non-Hodgkin lymphoma, 24 cases (12.57%) were metastatic neoplasm and 9 cases (4.7%) were other lesions.Conclusion: Tuberculosis was the most common cause of lymphadenopathy, followed by reactive lymphadenitis and the cervical group of lymph nodes was most frequently affected. DOI: http://dx.doi.org/10.3329/jemc.v2i1.11915 J Enam Med Col 2012; 2(1):8 -14

Prospective Study of Fine Needle Aspiration Cytology of Lymph Nodes of The Head And Neck Region over a 2 Year Period with Histopathological Correlation

Introduction: Fine needle aspiration cytology (FNAC) is a simple, quick and inexpensive method used to sample lymph nodes found in the head and neck region.1,2 Aims:1) To study the different cytomorphological patterns of FNAC associated with lymph nodes in the head and neck region. 2 ) To correlate the FNAC findings with histopathology. 3) To evaluate the sensitivity and specificity using histopathology as the gold standard. Material and methods: FNAC of 100 cases of lymph node swellings of head and neck region is included. 20 cases have histopathological correlation. Results: Cervical group of lymph nodes are most common presentation in both benign and malignant condition. Reactive lymphadenitis and metastasis are the most common benign and malignant condition respectively. Overall accuracy and sensitivity was 90% and 100% respectively 3,4 , Conclusion: FNAC is a very useful and accurate approach in diagnosing various benign and malignant lymphadenopathies.

Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis

Peripheral tuberculous lymphadenitis accounts for ~10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30-40 years, and dominant foreign birth, especially East Asian. Patients present with a 1-2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.

Hodgkin lymphoma: Clinicopathologic features in Benin City, Nigeria and update on its biology and classification

To review the age incidence, common pathohistologic subtypes, and anatomical nodal sites of lymph nodes involvement for histology. A 25 (May 1985-June 2010) years retrospective study of all patients who had lymph node biopsy. Department of Pathology and Haematology, University of Benin Teaching Hospital, Benin City, Nigeria. Of 821 lymph node biopsies encountered, 56 (6.8%) cases biopsied were for Hodgkin lymphoma (HL). There was a bimodal peak incidence of age interval of 11-15 years and 21-25 years and the relationship between the age and sex distribution was statistically significant (P = 0.03). The overall median age was 23 years with a mean age of 25.6 ± 2.0 (SEM). Pathological re-appraisal of these 56 cases in the study indicates that mixed cellularity HL constituting 36 cases (64.3%) was the predominant subtype. This was followed by lymphocyte depleted HL with a total of 11 cases (19.6%). The major site of lymph node involvement where biopsy was taken for histological diagnosis was the cervical group of lymph nodes constituting 78.6%. Staging classification of the disease indicates low frequency of early stage disease (I-II) with 19 cases (33.9%) and high frequency of late stage (III-IV) with 37 cases (66.1%). Patients are predominantly males, children and young adults presenting with cervical lymphadenopathy at late stage of the disease, and a dominance of mixed cellularity and lymphocyte depleted histological subtypes were observed.

Simultaneous Metastatic Papillary Thyroid Carcinoma and Carcinoid of the Small Intestine in the Cervical Lymph Node Group

Malignancies, primary or metastatic, and infections are the main causative factors that should be included in the differential diagnosis of cervical adenopathy. We present a 56-year-old woman who was admitted to our department because of a supraclavicular mass. A neck dissection was performed and two different masses were excised. The histopathological examination showed that the larger mass (measuring 5 cm) was a block of lymph nodes with metastatic papillary carcinoma of the thyroid. In the adjacent fibroadipose tissue, two lymph nodes with metastatic carcinoid tumor were found. The smaller mass (measuring 2 cm) was a lymph node with metastatic carcinoid tumor. The patient underwent total thyroidectomy with ipsilateral radical neck dissection. Histopatological examination of the thyroid gland showed a lesion of papillary carcinoma, measuring 0.6 cm. No further lesions of carcinoid were found. To our knowledge, this is the first report of a coexistence of metastatic papillary thyroid carcinoma and intestinal carcinoid tumor in cervical lymph nodes.

Relapse of leprosy presenting as nodular lymph node swelling

Lymphadenopathy is known to be associated with lepromatous leprosy and has also been observed as a feature of type-2 lepra reaction. However, nodular lymph node enlargement is not commonly reported in leprosy patients or as a feature of relapse. We herewith are presenting a case of bacteriological relapse in a patient of lepromatous leprosy treated 22 years before till smear negativity with WHO multidrug therapy (MDT) multibacillary type (MB). She presented with prominent nodular swelling of the cervical group of lymph nodes along with generalized lymphadenopathy, which was mistakenly treated as tubercular lymphadenopathy. A diagnosis of late bacteriological relapse of lepromatous leprosy presenting with prominent lymphadenopathy and ENL was made after relevant investigations. The patient was started on treatment with WHO MDT MB (daily dapsone and clofazimine and monthly rifampicin) and thalidomide (200 mg/day). Nerve pain regressed within 2 weeks of therapy. The lymph nodal swelling regressed within 3 months of starting treatment.

Patterns and Clinical Significance of Nodal Metastasis in Squamous Cell Carcinoma of Hypopharynx

Background and Objectives The aim of this study was to evaluate the incidence and prognostic significance of cervical lymph node metastasis in squamous cell carcinoma (SCC) of the hypopharynx. Subjects and Method A retrospective review of the 64 patients who were previously untreated for SCC of the hypopharynx and underwent surgery was performed from October 1993 to June 2008. Fifty-six patients had simultaneous bilateral neck dissection, whereas eight had unilateral neck dissection. Results The median age was 61.0 years (range, 34-75 years) for the study group consisting of 62 males and two females. Evaluating according to the N stages, there were 15 (23.4%), 10 (15.6%), 37 (57.8%), and 2 (3.1%) cases with N0, N1, N2 and N3, respectively. Forty-nine patients (76.6%) had pathologically proven cervical metastasis. Contralateral occult lymph node metastasis occurred in 20.5%. Ipsilateral and contralateral occult metastasis rates for clinically node negative patients were 41.2% and 11.8%, respectively. The most frequent sites for positive neck nodes occuring at each level were as follows: II (48.5%), level III (40.6%), level IV (26.6%), paratracheal node (21.4%), level V (9.4%), levels I (7.8%), and retropharyngeal node (6.3%). The 5-year overall survival and disease-specific survival rates were 50% and 53%, respectively. Cervical nodal metastasis (p=0.044) was statistically significant prognostic factors for disease-specific survival. Conclusion Metastasis to the cervical lymph node group is very frequent and has an impact on survival in patients with hypopharyngeal SCC. Therefore, we advocate bilateral neck dissection in patients with hypopharyngeal SCC with clinically positive metastasis. Ipsilateral elective neck dissection may be needed for clinically node negative patients.

Vulval lymphangiomata secondary to tubercular inguinal lymphadenitis with HIV

Acquisition of vulval lymphangiomata is a rare occurrence; clinically characterized by the presence of circumscribed eruptions of thin walled, translucent vesicles. Here, we report a case of 18-year-old HIV-positive female with multiple smooth to warty, flesh colored papules and nodules covering labia and mons pubis with bilateral inguinal linear puckered scars with enlarged right cervical group of lymph nodes. Our case is unique because of its association with HIV.

Isolated Primary Tuberculosis Of Inguinal Lymph Nodes: An Acute Presentation

Lymphadenopathy is a common manifestation of tuberculosis and is most commonly seen in children and adults alike with the involvement of the cervical group of lymph nodes. Isolated inguinal tubercular lymphadenopathy has been described but is a very rare presentation of tuberculosis. We present a case report and a review of literature of isolated tubercular inguinal lymphadenopathy presenting as acute lymphadenitis, which is even rarer.

The pattern of lymphatic metastasis of malignant tumors in the periorbital area

Background and objectives The rarity of malignant tumors in the periorbital area makes it difficult to assess the patterns of lymphatic spread and to determine the optimal extent of treatment. The objective of this study was to analyze the patterns of lymphatic metastasis in malignant tumors arising from the periorbital area according to the primary site and to assess the optimal extent of surgical treatment for these tumors. Materials and methods We retrospectively reviewed the medical records of 8 patients with malignant tumors in the periorbital area from January 1997 to June 2002. The mean duration of follow-up was 27.5 months. Five primary tumors were located in the medial half of the periorbital area, 2 tumors in both medial and lateral halves, and 1 tumor in the lateral half. The pathological diagnoses were 3 squamous cell carcinomas, 2 adenoid cystic carcinomas, 2 sebaceous carcinomas, and 1 basal cell carcinoma. Results The lymphatic metastasis was observed in 4 of 8 patients who had a relatively large (≥4 cm) primary tumor or poorly differentiated tumor. Four of 7 tumors involving the medial half of the periorbital area exhibited lymphatic spread to the periparotid lymph node and level II cervical lymph node groups. Conclusion The results of this study suggest that more aggressive management of the parotid area is necessary in malignant tumors arising from the periorbital area, even in the medial half of the periorbital area.

Non Burkitt′s non-Hodgkin′s lymphoma in Ile-Ife

To determine the frequency, age and sex patterns of non-Burkitt's non-Hodgkin's lymphoma among cases of lymphoma seen at the histopathology department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The records of patients with histologically diagnosed non-Burkitt's non-Hodgkin's lymphoma seen over a period of five years were studied. The classification was based on the Working Formulation. The sex and the age at diagnosis as well as the sites of the lesions were noted. Of the fifty three cases of non-Burkitt's non-Hodgkin's lymphoma seen during the study period 54.7% had intermediate grade tumours; 24.5% has low grade and 20.8% had high grade tumours. 92.5% of the cases occurred in adults over the age of 20 years. There was also a male predominance. Nodal as well as extranodal sites were involved and peripheral lymph node involvement most often affected the cervical group of lymph nodes. The results showed that non-Burkitt's non-Hodgkin's lymphoma is predominantly a disease of adults which more often affected males than females. The intermediate grade type with the possibility of cure is the type most often seen in this study. Therefore, early diagnosis and preventive measures against known risk factors in our environment, where possible, are strongly recommended.