Lymphadenopathy Of Unknown Etiology Research Articles

Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru.

.The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26–52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.

Uniportal video-assisted thoracic surgery in the diagnosis of mediastinal lymphadenopathy of unknown aetiology

Background: Recently endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been widely reported to be useful for patients with lung cancer for lymph node staging, and this tool may be the first line procedure for patients with mediastinal and hilar lymphadenopathy of unknown aetiology. However, more invasive techniques as mediastinoscopy and video-assisted thoracic surgery (VATS) are useful in well-selected patients, and surgery has a significant role in the evaluation of some areas in the mediastinum. The purpose of the current study was to investigate the clinical utility of VATS with the uni-portal approach in the diagnosis of mediastinal lymphadenopathies of unknown aetiology. Methods: Retrospective chart review of our VATS database between 2003 and 2013 (10-year experience) was performed. All mediastinal lymphadenopathies of unknown origin were included in the study and were classified and designated according to the International Staging System. Pathological diagnosis was determined in all patients and was classified into two categories: malignant lymphadenopathy and benign lymphadenopathy. Results: A total of 136 patients with mediastinal lymphadenopathy of unknown origin were identified, and the final diagnosis was available in all patients’ means of VATS surgery with uniportal technique. We no consider mediastinoscopy cases. The final diagnosis was available in all patients and was 114 malignant lymphadenopathies and 22 benign lymphadenopathies. VATS was safe (without complications) and had a sensitivity and a specificity of 100%, and it permits to study all areas of the mediastinum. Additionally, VATS surgery is accurate in the diagnosis of EBUS-TBNA negative lymphadenopathy (26 patients, 19%). Conclusions: VATS is a safe and reliable minimally invasive approach for a sampling of mediastinal and hilar lymphadenopathies, and it should be considered a second line procedure for a sampling of mediastinal tissue. However, in some areas of the mediastinum (anterior, posterior, left 5–6 lymph node stations) and in the cases where EBUS-TBNA fails, this is a winning tool for obtaining a pathological diagnosis of mediastinal disease. We also believe that for these patients are paramount a multidisciplinary approach.

Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto's disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.

Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology

The clarification of enlarged lymph nodes is a common issue in clinical routine. By now, open surgery with complete lymph node extirpation, followed by histopathology, is considered as standard. We investigated the value of fine needle aspiration (FNA) and core needle biopsy (CNB) when supporting the conventional morphology by immunotyping. In total, 101 lymph nodes (reactive, n = 19; lymphoma, n = 46; metastatic, n = 36) were examined. CNB specimens were sufficient for unequivocal diagnosis by histopathology in 95 %. The FNA cytology allowed a correct diagnosis in 49 %. When supported by immunocytology, the success rate improved to 72 %. By accepting "suspicious of" as correct diagnosis, the ratio increased to 91 %. Additional use of flow cytometry in 46 samples minimized the "suspicious of" diagnoses and increased the proportion of unequivocal diagnoses in FNA specimens to 87 %. Flow cytometry allowed a correct subtyping in 20 of 21 B cell lymphoma but recognised only one of five Hodgkin lymphoma. All eight reactive samples were correctly diagnosed by flow cytometry. In summary, CNB allows a reliable clarification of an unclear lymphadenopathy. FNA is a powerful first diagnostic approach, especially if cytology is supported by immunocytology. The most substantial contribution of flow cytometry in FNA is the discrimination between reactive lymphadenopathy and B cell lymphoma.

Significance of fine-needle aspiration biopsy of peripheral lymph nodes upon the initial presentation of patients with lymphadenopathy of unknown etiology

Fine-needle aspiration biopsy is safe, simple, cost-effective and efficient technique providing rapid information and, therefore, directing further approach to a patient. Its findings are especially beneficial for verification of lymphoid origin of the enlarged growth, diagnostics and differentiation of metastatic, infectious, reactive and lymphomatous conditions; determination of the extent of tumor; detection of recurrence; monitoring of the course of disease; obtaining of material for special studies such as microbiological cultures, immunological or genetic studies as well as electron microscopy; in addition, for encouragement of patient in case of benign nature of the disease. At the Institute of Hematology, in three-year period, a total of 193 fine-needle aspiration biopsies were performed in 172 patients with the enlarged peripheral lymph nodes. Technically, aspiration biopsy was successful in 175/193 attempted interventions (91%). Punctates were analyzed by cytomorphology and subsequently compared with histopathological findings. In indistinguishable cases, additional immunocytochemical streptavidin-biotin peroxidase staining was carried out. In our studies, immunocytochemical analysis was performed in 63 out of 81 patients (78%), and diagnostic accuracy was 93.6% what was compatible with the results of other authors. It significantly corrected the earlier cytomorphological-histological congruence that used to be 83%. Immunocytochemistry has contributed to diagnostic value of cytological analysis of punctate, before all, in view of its higher diagnostic accuracy, which, according to majority of authors, is about 90%.

Clinical-histologic-microbiologic analysis of 419 lymph node biopsy specimens.

The results of culture and histopathologic examination of 419 lymph node biopsy specimens obtained from 414 patients in 1978-1983 were correlated with clinical histories. The clinical diagnosis was lymphadenopathy of unknown etiology in 113 cases, sarcoidosis in 93, malignant lymphoma in 86, metastatic carcinoma in 17, histoplasmosis in 18, tuberculosis in 13, and other miscellaneous conditions in 79. All but two clinically significant microbial isolates from lymph nodes were either mycobacteria or fungi: the only exceptions were staphylococcal isolates from two children with lymphadenitis. Of 66 lymph nodes associated with bacterial, mycobacterial, or fungal disease, 48 included granulomatous and/or acute inflammatory lesions. Of 33 lymph nodes that were culture-positive, two had histologic evidence of lymphoid hyperplasia, and the remainder included granulomatous and/or acute inflammatory lesions. With one exception, lymph node cultures in immunocompetent patients were positive only when there was a granuloma and/or an acute inflammatory lesion in the tissue. On the basis of these findings, it was concluded that lymph nodes from immunocompetent patients should be cultured only when a granuloma and/or an acute inflammatory lesion are detected and that the cultures can be limited to mycobacteria and fungi.

A Patient with Aids

Susan Ball , M.D.. Chief Resident: Mr. B, a thirty-five-year-old white male, was admitted to the medical service with chief complaints of fever, chills, and increasing shortness of breath. This was Mr. B's second admission. His first was six month s ago for pneumonia, leukopenia, and lymphadenopathy of unknown etiology. At that time he was treated with antibiotics; he improved and was discharged. Since that time Mr. B reported continuing to feel weak and lethargic. Two weeks before this admission he noted the onset of fever, chills, sore throat, and a nonproductive cough. He initially saw a medical doctor for these complaints who diagnosed his problem as bronchitis and treated him with intramuscular injections that were probably antibiotic in nature. He continued to experience malaise and fever. Next he saw an otolaryngologist, who diagnosed Mr . B as having oral thrush. He was placed on Mycostatin Oral Suspensions , but continued to experience increasing fever, chills, shortness of breath , and sore throat, as well as a rthralgias, abdominal pain, and diar rhea. Shortly thereafter Mr. B was admitted to the hospital.