Enlarged Lymph Nodes In Patients Research Articles

Mediastinal lymphadenopathy in COVID-19: A review of literature.

A novel coronavirus disease 2019 (COVID-19) is a progressive viral disease that affected people around the world with widespread morbidity and mortality. Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal, cardiac, or neurological system dysfunction. Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation. Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies. It is commonly found to be associated with malignant diseases, sarcoidosis, and heart failure. Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection. We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection. Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD

sBackgroundLymph node (LN) metastasis is negligible in early gastric cancer (EGC) within expanded criteria for endoscopic submucosal dissection (ESD). However, regional lymph nodes in abdominal CT scans are sometimes enlarged in patients with EGC within the expanded criteria for endoscopic submucosal dissection (ESD). In this study, we investigated the clinical significance of regional lymph node enlargement on abdominal CT scan in patients with EGC within the expanded criteria for ESD.MethodsFrom December 2010 to April 2015, among 301 patients with EGC within the ESD expanded criteria, 47 patients with regional lymph node enlargement shown by abdominal CT scan were prospectively enrolled. We performed surgical resection or periodic follow-up with abdominal CT scans and upper endoscopy every 6 months to evaluate whether the enlarged lymph nodes are due to metastasis or a reactive change.ResultsThe mean age of the 47 patients (38 males, 9 female) was 64.8 years. The enlarged lymph nodes were usually single (26/47, 44.6%) and sized as follows: 11 nodes were ≤ 5 mm, 19 were 6–10 mm, and 17 were ≥ 10 mm. Four of the 47 patients initially underwent surgical resection, and 8 patients underwent surgical resection after ESD. However, there was no lymph node metastasis in surgical specimens. Thirty-five patients received ESD and periodically followed up at a median duration of 56 months (IQR: 44–59 month). The enlarged lymph node disappeared in 12 of 35 patients, decreased in 9 patients and remained the same size in 13 patients, and increased in 1 patient.ConclusionRegional lymph node enlargement on abdominal CT scan in patients within expanded criteria for ESD of ECG may be not due to metastasis but a reactive change.

Radiographic features of pulmonary tuberculosis in HIV-infected patients with different severity of immunosuppression and deviant behavior

The objective of this study was to investigate radiological features of pulmonary tuberculosis in HIV-infected patients with different severity of immunosuppression and deviant behavior. Methods. This was a single-center total observational retrospective study. The study involved 257 patients with pulmonary tuberculosis and NIV-infection who was treated and followed at a penitentiary tuberculosis hospital. Results. Tuberculosis-associated lung lesions were diagnosed in 94.2% of patients. Extrapulmonary and generalized tuberculosis increased with worsening immunity. Majority of patients were 20 – 29 and 30 – 39 years old. Typical radiological features included lung root lesions due to hilar lymph node enlargement in patients with CD4 lymphocytes < 100 cells/µL. CD4 lymphocytes decrease < 100 cells/µL was more likely in patients with involvement of ≥ 3 lung lobes and less likely in patients with involvement of 1 or 2 lung segments. CD4 lymphocytes decrease < 100 cells/µL was associated with prominent lung tissue infiltration (39.0%); moderate infiltration of the lung tissue did not depend on immunosuppression. Cavitation ≤ 2 cm was frequent (76.9 – 96.0%), mostly in the right lung (36.4 – 53.8%) and did not depend on immunosuppression. Conclusion. The most prevalent pulmonary tuberculosis in HIV-infected patients was infiltrative tuberculosis independently on CD4 lymphocyte number.

Mediastinal Lymph Node Enlargement in Patients with Valvular Heart Disease: CT Evaluation and Clinical Correlation

Computed tomography (CT) findings of thoracic abnormalities related to congestive heart failure are widely reported in the literature (1). Enlarged mediastinal lymph nodes are also known to occur in patients with congestive heart failure in several reports (2, 3). Hence, it might be useful to identify mediastinal lymphadenopathy and other pulmonary findings associated with heart disease on CT so that invasive diagnostic approaches such as lymph node biopsy to demonstrate a benign origin can be avoided. Several previous studies have evaluated mediastinal lymph node enlargement associated with congestive heart failure, including heterogeneous disease groups such as myocardial infarction, left-sided heart failure, biventricular heart failure, etc. (2, 4). However, in previous studies, cardiac disease-specific evaluations of mediastinal lymphadenopathy are not reported. Valvular disease is one of the most common causes of heart disease encountered in clinical practice. Despite several reports on Mediastinal Lymph Node Enlargement in Patients with Valvular Heart Disease: CT Evaluation and Clinical Correlation 심장판막질환 환자에서 종격동 림프절 크기증가에 대한 전산화단층촬영 소견 분석과 임상적 의의

The significance of paracardiac lymph-node enlargement in patients with newly diagnosed stage IIIC ovarian cancer

ObjectiveExtra-abdominal metastases in epithelial ovarian cancer (EOC) are relatively rare. Interpreting computed tomography (CT) scans, during initial work-up, little attention is focused on enlargement of paracardiac lymph nodes (PCLN) and their significance is not clear. We aimed to examine whether the presence of PCLN during initial diagnosis of EOC influences prognosis. MethodsA retrospective study comparing patients with stage 3 EOC who were diagnosed with PCLN on CT scan during initial evaluation to stage 3C patients without PCLN. Scans were reviewed by a single radiologist for peritoneal involvement, distal metastases and presence of PCLN. Disease status at diagnosis, results of surgery, chemotherapy and response, disease-free interval (DFI) and overall survival (OS) were recorded. ResultsThirty one patients with stage 3C EOC with PCLN on initial CT scan were included and compared with 41 controls. There was no significant difference between groups in abdominal optimal cytoreduction rate. Lower rates of complete response (CR) to initial treatment were detected in the study group (45.2% vs. 78.0%, p=.004). In survival analysis, the DFI for patients with PCLN was shorter (median 9.0 vs. 24.0months, p=.0097) and overall survival was shorter (median 31.7 vs. 61.3months, p=.001). Multivariate analysis showed that PCLN was significantly associated with a lower rate of CR, a shorter DFI and a shorter OS. ConclusionThe presence of enlarged PCLN at presentation appears to be associated with poor prognosis in stage 3C EOC. Further attention should be given to detection and follow-up of such findings when considering treatment.

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: A three year study at tertiary center

Background: Lymphadenopathy is a common presenting symptom in various diseases. Objective: The present study was undertaken to evaluate the usefulness of fine-needle aspiration cytology (FNAC) as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies. Materials and Methods: The present study was conducted in the department of pathology, Shri M.P. Shah Medical College, Jamnagar from June 2008 to July 2011. FNAC of the enlarged lymph nodes was performed with informed consent of the patient. Totally 1022 patients of lymphadenopathy who underwent FNAC were divided into three groups: Group I (0-20 years), Group II (21-50 years) and Group III (>51 years). Results: Maximum number of patients with lymphadenopathy was in Group II: 502 (49.11%), followed by Group I: 378 (36.98%) and in Group III there were 142 (13.90%) cases. Most common causes of lymphadenopathy in different groups were found to be: In Group I: Reactive hyperplasia 198 cases (52.38%), Group II: Tubercular lymphadenitis 232 cases (46.21%) and Group III: Metastatic carcinoma 80 cases (56.33%). Conclusion: It was concluded that different etiological factors play a role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy.

Endobronchial ultrasound: first choice for the mediastinum.

The world's first curved linear array ultrasonic bronchoscope was introduced to the market by Olympus in 2004. The development of the endoscope had started more than 5 years earlier based on a request to Olympus Medical Tokyo to miniaturise existing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) technology to be applied for diagnosis of lesions within the bronchial system. The appeal was born out of the necessity to improve mediastinal staging results. Computed tomography (CT) and positron emission tomography (PET) are the most widely used non-invasive means for mediastinal lymph nodes. However, based on their reported specificities, CT and PET findings should be verified by cytohistologic sampling.1 The 60-year-old transbronchial needle aspiration (TBNA) technology has proved its efficacy, safety and cost-effectiveness particularly in diagnosing and staging lung cancer as well as in diagnosing benign granulomatous disease, but unfortunately the technique was always underused. Mainly safety concerns have been the reason.23 The success story of endobronchial ultrasound (EBUS)-TBNA starts in 2003 with a publication in the journal Thorax by Krasnik et al.4 This article gave the first description of the principle of EBUS-TBNA. In the same journal, Herth et al.2 chronicled their study on 502 patients that showed that EBUS-TBNA resulted in 93% diagnostic yield, a sensitivity of 94%, specificity of 100% and accuracy of 94%, with a positive predictive value at 100% and negative predictive value at 11%. A further interesting outcome of the study was that no significant difference between ultrasound diagnosis under local and general anaesthesia was identified. With the strong acceptance of EBUS-TBNA as a reliable diagnostic tool for enlarged lymph nodes in patients with non-small cell lung cancer (NSCLC), it soon became clear that EBUS provides the best lymph nodes access. The technique was also examined against mediastinoscopy. In a study by Ernst et al.5 it was shown that EBUS-TBNA can have a superior yield compared with cervical mediastinoscopy, which leads to the conclusion that mediastinoscopy is not necessarily of additional diagnostic benefit to evaluate negative EBUS-TBNA staged lymph nodes. A lot of very important work was also done by Nakajima et al.6789 He and his group have shown strong dedication to evaluate the benefits of EBUS-TBNA samples for immunohistochemical analysis, molecular staging and reported encouraging results with cell cycle related proteins in chemotherapy patients. In several published meta-analysis, EBUS-TBNA has been shown to have a high-pooled sensitivity of 93% and specificity of 100%.101112 Multiple publications have shown that even in patients with lymph nodes <1 cm in diameter (which had been termed N0 by CT criteria), with the use of EBUS-TBNA a large percentage could still be shown to have N2/N3 disease (some despite also being negative on PET-CT).1314 Complications such as bleeding or infection are very rare and have only been reported as case reports. At least it was the work of Annema et al.15 which also convinced guidelines authorities. In a randomized controlled multicenter trial patient either underwent a surgical staging or an endosonography (combined transesophageal and [EUS-FNA and EBUS-TBNA]) followed by surgical staging in case no nodal metastases were found at endosonography. Thoracotomy with lymph node dissection was performed when there was no evidence of mediastinal tumor spread. The group showed that among patients with (suspected) NSCLC, a staging strategy combining endosonography and surgical staging compared with surgical staging alone resulted in a greater sensitivity for mediastinal nodal metastases and fewer unnecessary thoracotomies. All the work changed at the end of our daily doing. The recent published guideline of the American College of Chest Physicians (ACCP) is clearly pointed now. In the article by Silvestri et al.,16 the ACCP recommends “In patients with high suspicion of N2 and 3 involvement, either by discrete mediastinal lymph node enlargement or PET uptake (and no distant metastases), a needle technique (EBUS-needle aspiration [NA], EUS-NA or combined EBUS/EUS-NA) is recommended over surgical staging as a best first test (Grade 1b).” After 10 years and a lot of scientific work from several groups, a small scope becomes the state of the art.

Patterns of enlarged lymph nodes in patients with metastatic renal cell carcinoma

Objective We reviewed the imaging studies of patients with known metastatic renal cell carcinoma (RCC) in order to more accurately assess where retroperitoneal lymphadenopathy occurs. Methods The database of patients with metastatic RCC was reviewed and 101 patients were found from 2002 to 2006. Each patient's CT scans were then reviewed. Twenty-seven retroperitoneal sections were defined for each patient, with 3 positions in each of the x-, y-, and z-axis. Lymph nodes greater than 1 cm were then counted for each section. Results Of the 101 patients, 31, of whom 28 qualified, were found to have retroperitoneal lymphadenopathy of a least 1 cm or greater. Two-thirds of nodes (87 out of 124) exhibited a suprahilar, intra-aortocaval, and retro-aortocaval trend of lymph node enlargement. Three patients (11%) had isolated infrahilar nodes, while 8 patients (29%) exhibited a skip lesion pattern by imaging criteria. Only 4 patients (14%) were noted to have lymph nodes that were confined to the ipsilateral (paraaortic or paracaval) nodes in the perihilar and infrahilar region, which would be readily accessible during renal surgery. Conclusions Lymphatic drainage in RCC is ill-defined, likely due to multiple lymphatic outflow channels. However, after a review of retroperitoneal lymphadenopathy imaging in patients with known metastatic RCC, there does seem to be a cephalad, posterior, and medial drainage pattern.

Evaluation of etiology of lymphadenopathy in different age groups using Fine Needle Aspiration Cytology: A retrospective study

Background: Lymphadenopathy is a common presenting symptom in various diseases. Lymph nodes react to various stimuli and undergo changes leading on to vast array of neoplastic or non-neoplastic proliferations. FNAC is a simple, quick and inexpensive method that is used to sample superficial masses and is now considered a valuable diagnostic aid. Objective: The present study was undertaken to evaluate the usefulness of FNAC as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies.Settings and design: Retrospective study conducted in the Department of Pathology, Subharti Medical College, Meerut from July 2006 to June 2009 (3years).Material and Methods: Total 1350 patients of lymphadenopathy who underwent FNAC were divided into 3 groups: Group I including pediatric patients (i.e. 0-15 years), Group II including adolescent and middle aged patients (i.e. 16-45 years) and Group III with elderly patients (i.e. >45 years).Observation: Maximum number of patients with lymphadenopathy was in Group II with 640 patients (47.4%), followed by Group I: 498 patients (36.89%) and Group III: 212 patients (15.7%). Commonest causes of lymphadenopathy in different groups were found to be: In Group Ireactive hyperplasia 353(70.88%), Group IITubercular lymphadenitis 261(40.78%) and Group IIIMetastatic carcinoma 115(54.25%).Conclusion: It was concluded that different etiological factors play role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy. Work Attributed To –Department Of Pathology, Subharti Medical College, Meerut ,U.P., India. Financial SupportSubharti Medical College, Meerut, U.P., INDIA.

Value of Frozen Section Analysis of Enlarged Lymph Nodes During Radical Nephrectomy for Renal Cell Carcinoma

To avoid unnecessary lymphadenectomy for renal cell cancer (RCC) in patients with retroperitoneal enlarged lymph nodes (ELNs). Frozen section examination (FSE) of ELNs was used to evaluate the lymphatic status. In the present study, 114 patients with RCC underwent FSE of ELNs and concurrent regional lymphadenectomy. The results of FSE were compared with the final histopathologic results of lymphadenectomy. Some clinical tumor characteristics were also considered to improve the evaluation effect of the FSE. Multiple regression analysis was applied to define the independent risk factors for lymphatic metastasis. The final histopathologic results indicated that 36 patients (31.6%) had nodal metastases. In these 36 patients, the FSE of ELNs revealed positive findings in 32 patients and negative findings in 4 patients. The sensitivity, specificity, concordance, and false-negative rate of FSE was 88.9%, 100%, 96.5%, and 11.1%, respectively. Multivariate analysis revealed that distant metastasis and high T stage (T3-T4) were independent risk factors for lymphatic metastasis. When FSE indicated negative results, no nodal metastases were found (64 patients) without these 2 risk factors. ELNs in patients with RCC do not necessarily indicate metastatic disease, and more than one half of ELNs were benign. FSE of ELNs can be used to evaluate the lymphatic status. Using the findings from FSE and the clinical characteristics of the primary tumor, we can avoid unnecessary lymphadenectomy in patients with retroperitoneal ELNs.

Bihiläre Lymphome bei nichtseminomatösem Keimzelltumor

Intrathoracic enlarged lymph nodes in patients with malignant diseases always arouse suspicion of lymphatic metastases. Despite modern diagnostic investigation, surprising findings sometimes emerge. The present case of a young man with intrathoracic lesions in association with a germ-cell tumor of the testis turned out to have sarcoidosis mimicking testicular cancer relapse.

The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring > or =16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

Frequency of lymphadenopathy in rheumatoid arthritis and systemic lupus erythematosus.

This study aimed to assess the frequency of all palpable lymph nodes during active disease and remission in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Hospital records of 100 SLE patients, 100 RA patients, 100 spondyloarthropathy patients, and 150 osteoarthritis patients, treated in our rheumatology department, were evaluated retrospectively. Overall frequencies of enlarged lymph nodes in patients with active RA and SLE were 82% and 69%, respectively. Enlarged lymph nodes associated with RA were mostly located in the axillary region, and in SLE the nodes were smaller and lymphadenopathy was more generalized compared with RA. Palpable lymph nodes disappeared in the majority of patients during remission. Lymphadenopathy was significantly less frequent in patients treated with steroids before admission. Lymph node enlargement is an important physical finding associated with RA and SLE disease activity. Atypical locations and unusually large lymph nodes should raise clinical suspicion of another underlying disease.

Infiltration of cervical lymph nodes by B- and T-cell non-Hodgkin's lymphoma and Hodgkin's lymphoma: preliminary ultrasonic findings.

Ultrasonography has been used in the evaluation of enlarged lymph nodes in patients with malignant lymphoma, which comprises a variety of histopathological subtypes. We assessed ultrasonic findings of infiltration in cervical lymph nodes of 47 patients with previously untreated malignant lymphoma and correlated them with histopathological subtypes. Common findings among various histopathological subtypes were hypoechoic masses, spot and/or line echoes, involvement of multiple nodes, and posterior enhancement. In addition, each histopathological subtype showed characteristic findings: Hodgkin's disease had a contour with a lobular pattern (9/10 cases), septum-like echo (9/10 cases), and tubular structure (9/10 cases) in the internal echo, reflecting histopathologically fibrous connective tissue surrounding lymph nodes and small vessels. In B-cell lymphoma, there was characteristically a tendency for lymph node fusion (19/28 cases) and spot and/or line echoes (17/28 cases), reflecting histopathological replacement and destruction of the structure of lymph node and capsule by proliferation of lymphocytes. These findings were strengthened in diffuse large B-cell lymphoma. T-cell lymphoma was distinguished from other types of lymphoma by the presence of a hilum-like echo (6/9 cases), reflecting histopathologically prominent vascularization in lymph nodes accompanied by a dilated hilum area. In summary, this preliminary study suggests that ultrasonic findings of infiltration of cervical lymph nodes in major subtypes of malignant lymphoma could reflect characteristic histopathological structures, therefore providing information helpful for differentiating them.

Enlargement of Regional Lymph Nodes in Renal Cell Carcinoma is Often not Due to Metastases

Preoperative axial computerized tomography scans in 163 patients with renal cell carcinoma were reviewed to assess the predictive value for the diagnosis of regional lymph node metastases. Computerized tomography was falsely negative in 5 patients: 2 had metastatic lymph nodes in the renal hilus adjacent to the primary tumor measuring 2 and 2.5cm., and 3 had micrometastases in nodes of less than 1cm. In 43 patients enlarged lymph nodes with a diameter of 1 to 2.2cm. (median 1.4cm.) were diagnosed on the preoperative scan and this was confirmed at nephrectomy and pathologically. In 18 of these 43 patients (42%) histological study showed metastases of the renal cell carcinoma in the enlarged lymph nodes. In the other 25 patients (58%) the enlarged nodes showed only inflammatory changes and/or follicular hyperplasia. This finding was significantly more frequent in patients with tumor involvement of the renal vein and tumor necrosis (p = 0.0044).We conclude that the sensitivity of preoperative computerized tomography is good for the detection of enlarged lymph nodes in patients with renal cell cancer (95%). However, significant lymph node enlargement frequently may be caused by inflammatory changes, especially in the presence of tumor necrosis. This radiological finding should not be misinterpreted as metastatic disease, unless it has been proved cytologically by fine needle aspiration.

Lymph node enlargement in patients with unsuspected human immunodeficiency virus infections

The histologic findings in lymph nodes were used to identify eight patients, who are not in a high-risk group, with human immunodeficiency virus (HIV) infection. In order to determine the specificity of these findings, the histologic and clinical findings in these patients were compared with the histologic and clinical findings in 40 patients whose lymph nodes exhibited reactive follicular hyperplasia and who received biopsies before 1981. While a definitive diagnosis of HIV infection cannot be made from the histologic changes in lymph nodes because the organisms cannot be identified, our findings indicate that HIV infection can be suggested, and appropriate testing warranted, when marked reactive follicular hyperplasia with mononuclear cells (and a small number of neutrophils) in parafollicular sinuses is found in a patient with unexplained lymph node enlargement at two or more noncontiguous, noninguinal sites for several months, with or without systemic symptoms.

The Value of Computerized Tomography in Evaluation of Pelvic Lymph Nodes

To assess the accuracy of computerized tomography in the preoperative detection of pelvic lymph node enlargement we evaluated prospectively 23 patients with potentially resectable cancer of the prostate. Subsequent staging pelvic lymphadenectomy revealed falsely negative studies in 7 patients and a falsely positive study in 1. The inaccuracy of computerized tomography mitigates against its use as a preoperative staging modality and confirms the value of pelvic lymphadenectomy as a means of detecting pelvic lymph node enlargement in patients with cancer of the prostate.

Carcinoma of the thyroid with description of a new scanning technic

A statistical analysis of 193 patients with thyroid carcinoma encountered at Vanderbilt University Hospital from 1925 to 1974 is reported, from which the following conclusions are drawn: (1) Papillary thyroid carcinoma is an extremely favorable lesion that when grossly limited to one thyroid lobe can usually be managed successfully by ipsolateral total lobectomy. (2) Cervical lymph node enlargement in patients with papillary carcinoma requires lymph node dissection. When feasible, the spinal accessory nerve should be preserved. (3) Failure to cure papillary and follicular thyroid carcinoma is influenced by advanced age, inadequate local extirpation, and unresectability of the carcinoma. (4) Prophylactic lymph node dissection is rarely indicated in the treatment of follicular carcinoma. A new isotope scanning procedure, developed at Vanderbilt University Hospital, promises to be helpful in preoperatively differentiating benign from malignant solitary thyroid nodules.