Lymphadenopathy Research Articles

Contribution of 18F-FDG PET/CT imaging in the diagnosis and management of HIV-positive patients

Introduction and objectivesThe human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body’s own defenses against diseases. This study was aimed to explore the value and significance of 18F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in 18F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients. Patients and methodsForty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, 18F-FDG uptake patterns were evaluated. Semiquantitative analysis of 18F-FDG uptake was performed and SUVmax were calculated. ResultsTwenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections. ConclusionsThe pattern of distribution of nodal/extranodal uptake on 18F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, 18F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV.

ENT manifestations in HIV infected patients in PIMS Islamabad.

INTRODUCTION
 HIV is a global pandemic with estimation of 38 million active cases around the world according to WHO HIV data and statistics 2019. Despite of advancement in medical field the disease has not been tamed uptil now. In this modern era HIV is still considered a taboo in Pakistan, people are reluctant about disclosure of disease, screening of their partners and its treatment which is due to lack of awareness and socio-economic constraints.
 OBJECTIVE
 The aim of this study is to see the incidence of Ear, Nose and Throat (ENT) manifestations in HIV infected people presented in tertiary care hospital of Islamabad.
 MATERIAL AND METHOD
 A one-year observational cross-sectional study conducted in Pakistan Institute of Medical Sciences (PIMS) Islamabad between January 2019 to December 2019. All the HIV infected patients who presented with ear, nose and throat manifestations were recruited in the study. Detailed history and examination were conducted after taking written consent. Analysis included calculations of mean values of quantitative association between ENT symptoms and demographic characteristics. Statistical analysis was estimated using either Chi-square test or t-test. 
 RESULTS 
 Majority of the patients presented with Otological manifestation of which the most common was chronic suppurative otitis media (14.28%). Most common Rhinological/Oropharyngeal manifestation included epistaxis (12.24%) and oral candidiasis (8.16%) respectively. Among neck manifestations cervical lymph adenopathy (18.16%) showed the highest percentage.
 CONCLUSION
 The study shows a local trend of ENT manifestation in which the patient presented in later stage (WHO III) which resembled to the studies carried out in other developing countries showing ineffectiveness of current national HIV/AIDS programme.

Elucidating the Etiologies of 18F-fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Among Cancer Patients in a Tuberculosis-Endemic Region Using Endobronchial Ultrasound.

BackgroundNon-malignant conditions, including infections (such as tuberculosis [TB]), can mimic malignancy with regards to their uptake of 18F-fluorodeoxyglucose (18F-FDG) tracer utilized for positron emission tomography-computed tomography (PET-CT) scan, as part of the diagnostic and staging workup of cancer patients. This poses a diagnostic challenge, for which tissue sampling is decisive. In this study, we aimed to determine the underlying etiologies of 18F-FDG-avid mediastinal lymph nodes among cancer patients in a TB-endemic demographic using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the respective sensitivity and specificity of PET-CT and EBUS in diagnosing malignancy.MethodologyIn this retrospective cross-sectional study, we analyzed the data of all cancer patients with 18F-FDG-avid mediastinal lymphadenopathy on diagnostic PET imaging, who later underwent EBUS-TBNA between July 2013 and December 2018 at our center. Logistic regression analysis was used to determine the relative risk of lymph node characteristics with malignant TBNA cytology, based on which a risk stratification model was formulated.ResultsA total of 178 patients were included in this study, comprising predominantly males (60.7%). The primary malignancy was lung cancer in 33 (18.5%) patients, while 145 (81.5%) had non-lung cancer. A total of 214 18F-FDG lymph nodes were sampled, out of which TBNA revealed malignant cytology in only 44 (20.6%). The final diagnosis was malignancy, TB, and sarcoidosis in 42 (23.6%), 16 (9%), and 12 (6.7%) patients, respectively. Among the remaining, 98 (55%) patients were determined to have only reactive lymphadenopathy, of which 24 (24.5%) had nodal anthracosis, while TBNA was inadequate for the diagnosis in 10 (5.6%) patients. An increased risk of malignancy was associated with the size of lymph node [odds ratio (OR): 1.58 (confidence interval (CI): 1.19, 2.11; p = 0.001], the standard uptake value (SUV) of the lymph node on PET-CT [OR: 1.30 (CI: 1.15, 1.45); p = 0.001], and with primary lung malignancy [OR: 4.44 (CI: 1.96, 10.06); p = 0.001]. At an SUV cut-off value of 6.0, PET-CT had the sensitivity, specificity, positive predictive value, and negative predictive value of 73%, 70%, 49.3%, and 91.8%, respectively, for diagnosing malignancy, while the same for EBUS was estimated to be 93.3%, 100%, 100%, and 97%, respectively.ConclusionsIn addition to TB, benign etiologies including nodal anthracosis and sarcoidosis predominate as causes of 18F-FDG-avid mediastinal lymphadenopathy in cancer patients of a TB-endemic demographic. The predictable risk of malignancy on PET imaging increases with nodal size, SUV, and lung primary malignancy; however, EBUS clearly demonstrates a higher sensitivity.

Predictors of Central Nervous System (CNS) Involvement in North American Adult T-Cell Leukemia Lymphoma (ATLL) and Their Survival Pattern

▪Introduction:North American-ATLL (NA-ATLL) is a distinct genomic and clinical entity when compared with Japanese ATLL. Despite the frequent CNS involvement by this entity there are no prognostication tools to identify variables associated with higher risk. We studied one of the largest NA-ATLL cohorts in the United States at a minority rich ethnically diverse New York City based tertiary care center to identify discrete variables that may be associated with CNS involvement. Additionally, we examined the predictive power of the previously validated International Prognostic Index (IPI) developed for Diffuse Large B-cell Lymphoma (DLBCL) in terms of CNS involvement as well as overall survival in our cohort.In our previous work, we assigned CNS involvement of ATLL if: 1) cerebrospinal fluid (CSF) cytology or flow cytometry was positive; 2) CNS imaging was positive for disease involvement or 3) physical exam was compatible with neurologic involvement.Methods and results:Of 65 NA-ATLL patients (pts), 20 (30.77%) had CNS involvement by ATLL meeting above mentioned criteria. The median age of all pts in our dataset was 59 years. Pts were divided into non- CNS involved NA-ATLL (non-CNS NA-ATLL) and CNS involved NA-ATLL (CNS NA-ATLL) groups. Parameters to predict CNS involvement were outlined as leukocytosis (>11000 per microliter [μL]), elevated acute lymphocytic count (>4000/ μL), elevated lactate dehydrogenase (LDH) (>190 units/liter [u/l]), generalized lymphadenopathy (LAD) defined as involvement of 2 or more non-contiguous nodal sites, elevated corrected serum calcium levels (>10.5 mg/deciliter), bone marrow (bm) involvement and serosal involvement defined as pleural or peritoneal involvement. These variables were chosen given our prior work identifying them as critical to predict OS in our general NA-ATLL population.We then performed the Fisher test of proportions to determine if the variables above mentioned were different between the CNS NA-ATLL and the non-CNS NA-ATLL. We did not find significant associations when analyzing gender (p=0.0535), leukocytosis (p= 0.4001), lymphocytosis (p =0.57), hypercalcemia (p= 0.7661), elevated LDH (p= 0.4898), generalized LAD (p=0.271), serosal involvement (p= 0.05088) or bone marrow involvement (p=1). We only found a strong association when examining ATLL subtypes, being the acute/lymphomatous variant strongly associated with CNS involvement (p=2.226e10 -5).To identify variables that can have an impact in OS in CNS NA-ATLL vs non-CNS NA-ATLL we calculated Kaplan Meier survival curves. We did not find any difference based on age (p=0.23), gender (p=0.95), leukocytosis (p= 0.074), lymphocytosis (p =0.21), hypercalcemia (p= 0.094), elevated LDH (p= 0.37), generalized LAD (p=0.28), and serosal involvement (p= 0.1) in the overall survival. The only significant association we found was bone marrow involvement in predicting poor OS in CNS NA-ATLL group (p= 0.038).Next, we determined IPI scores (age>60, ECOG performance status>2, Ann Arbor stage III/IV, serum LDH score >190 u/L and more than 1 extra-nodal site) in our CNS NA ATLL and non-CNS NA ATLL cohorts. We sought to determine if: 1) this prognostication tool is predictive in NA-ATLL and 2) if these variables can be used to identify CNS involvement in our cohort.CNS pts with a higher IPI score (>3) showed tendency towards a lower survival rate (p=0.089) than non-CNS pts (p=0.3). IPI score of 3 or more was not predictive of CNS involvement in our sample (p=1).Conclusions:NA-ATLL is a rare and protean disease with poor prognosis and CNS involvement is prevalent. With the variables used we did not find clear predictors of CNS associated disease other than patients presented with the lymphomatous and acute subtypes. We also observed than bone marrow involvement portends a dismal prognosis for individuals with CNS involvement. Future studies with a larger cohort could provider further insight on discovering predictors for CNS involvement in NA ATLL. [Display omitted] DisclosuresShah: Celgene/BMS: Research Funding; Janssen: Research Funding. Gritsman: iOnctura: Research Funding. Shastri: GLC: Consultancy; Kymera Therapeutics: Research Funding; Guidepoint: Consultancy; Onclive: Honoraria. Verma: BMS: Research Funding; GSK: Research Funding; Incyte: Research Funding; Medpacto: Research Funding; Curis: Research Funding; Eli Lilly: Research Funding; Stelexis: Consultancy, Current equity holder in publicly-traded company; Novartis: Consultancy; Acceleron: Consultancy; Celgene: Consultancy; Stelexis: Current equity holder in publicly-traded company; Throws Exception: Current equity holder in publicly-traded company. Janakiram: Amgen: Honoraria.

CASE REPORT: FOLLICULAR LYMPHOMA PRESENTED WITH CHYLOTHORAX

Chylothorax is the leakage of chylous contents into the pleural space as a result of damage to the thoracic duct. Chylous effusion is seen often unilateral but may be bilateral rarely. Etiology includes non-traumatic and traumatic causes. While sarcoidosis, amyloidosis, superior vena cava thrombosis and congenital anomalies are non-traumatic causes, non-Hodgkin lymphomas are the most common causes.Herein, we present a follicular lymphoma patient who was presented chylothorax at diagnosis. A 31-year-old male patient presented with fatigue, and dyspnea. On physical examination, inguinal and axillary multiple palpable lymphadenopathies (LAP) were observed, and respiratory sounds were significantly decreased on the left side.Computed tomography imaging revealed prevascular, paratracheal, subcarinal LAPs and 5 cm thick pleural effusion in the deepest part and compression atelectasison the left. Excisional LAP biopsy revealed follicular lymphoma When thoracentesis was performed and milky effusion was classified as an exudative. The high triglyceride level was consistent with a chylous effusion. After 6 cycles of R-CHOP treatment, the patient had a significant regression in the initial LAPs, while the chylous effusion persisted. When cytological examination of thoracentesis did not reveal lymphoma, the patient was followed-up. Chylothorax is associated with significant morbidity and mortality if left untreated. Control of the underlying malignancy is still the mainstay of treatment and reported as the most effective. In the literature, successful results were reported with the treatment of the underlying lymphoma. owever, it is known, chylothorax may recur and patients should be follow-up closely.

Disseminated Kaposi Sarcoma.

Case PresentationA 28-year-old male with a recent diagnosis of human immunodeficiency virus presented to the emergency department with odynophagia and dysphagia for a month. Physical exam revealed Kaposi sarcoma partially occluding the airway. Point-of-care ultrasound was used to assist with the diagnosis of reactive lymphadenopathy, and computed tomography revealed systemic disease. Otolaryngology was urgently consulted, and the patient was admitted for prompt tracheostomy the following day.DiscussionKaposi sarcoma is a violaceous vascular neoplasm that is an acquired immuno-deficiency syndrome (AIDS)-defining illness. Mucocutaneous membranes should be thoroughly evaluated with patients suspected of AIDS. This case demonstrates the vital evaluation of the patient’s airway to assess patency. Highly active antiretroviral therapy should be initiated promptly, as well as chemotherapy in severe systemic cases.

The incidence and duration of COVID-19 vaccine-related reactive lymphadenopathy on 18F-FDG PET-CT

Reactive axillary lymph nodes (ALN) may occur post-COVID-19 vaccination. This may be confused with malignant nodal metastases on oncological imaging. We aimed to determine the reactive ALN incidence and duration on 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET-CT), and its relationship with gender, age and vaccine type. A retrospective study was performed. Two-hundred and four eligible patients had 18F-FDG PET-CT between 01 January 2021 and 31 March 2021, post-vaccination with Pfizer-BioNTech or Oxford-AstraZeneca vaccine. Image analysis was performed on dedicated workstations. SPSS was used for statistical analysis. Thirty-six per cent of patients had reactive ALN until 10 weeks post-vaccination; reducing in frequency and intensity with time. Women were more likely to have reactive ALN compared with men. The frequency and intensity were higher in patients aged <65 years compared with those aged ≥65 years. However, no difference was found between both vaccine types in our study cohort. Physicians' awareness of COVID-19 vaccine-related reactive ALN on 18F-FDG PET-CT is important to avoid inappropriate upstaging of cancers.

Splenic kaposiform hemangioendothelioma presenting as insidious consumptive coagulopathy

Splenic kaposiform hemangioendothelioma presenting as insidious consumptive coagulopathy

STUDY OF LYMPH NODE CYTOLOGY IN HIV INFECTED PATIENTS

Background and Aim: Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. This study was performed to evaluate the role of FNAC as a cytological investigative tool in the diagnosis of various lesions in HIV lymphadenopathy.&#x0D; Material and Methods: This study was carried out in Tertiary care Institute of India, over a period of one year. Total 50 cases of HIV lymphadenopathy patients were participated in the study after having signed the Informed Consent Form. Diagnosis of HIV was done by enzyme linked immunosorbant assay (ELISA) test, followed by the CD4 counts by BD FACS Count system in HIV positive patients. FNAC procedure was performed as an OPD procedure in cytology OPD of pathology department.&#x0D; Results: Most common site of HIV lymphadenopathy is cervical lymph node 40 (80%), followed by supraclavicular 6(12%) followed by axillary lymph node 4(8%). The most common lesion found was mycobacterial infection 22(44%), followed by reactive lymphadenitis 15(30%). Non-specific chronic granulomatous lymphadenitis in 10(22%) and 3(6%) cases of acute suppurative lymphadenitis. CD4 count more than 500 cells/ µL was seen in 9 (18%) cases of reactive lymphadenitis and 4 (8%) cases of chronic granulomatous lymphadenitis. Patients with tubercular infection had CD4 count between 200- 499 cells/ µL in 12 (24%) cases and less than 200 in 10 (20%) cases.&#x0D; Conclusion: FNAC is relatively inexpensive and valuable tool for identification of opportunistic infections, neoplastic lesions and non-neoplastic lesions. It may spare patients lymph node excision and enable immediate treatment of specific infection. This procedure is readily repeatable and can be used for follow up during and after treatment.&#x0D; Keywords: Human immunodeficiency virus, lymphadenopathy, Non-specific chronic granulomatous lymphadenitis, tuberculosis

Adult-onset Still\u2019s disease with multiple lymphadenopathy: a case report and literature review

BackgroundAdult-onset Still’s disease (AOSD) often presents with systemic multiple lymphadenopathy. In addition to the common paracortical and mixed patterns in AOSD lymph node histopathological features, other morphological patterns include diffuse, necrotic, and follicular patterns. However, to date, there have been few reports on the histopathological description of AOSD lymph nodes.Case presentationAn 18-year-old woman presented 2 months earlier with pain in her large joints with painless rash formation; bilateral posterior cervical lymph node, left supraclavicular lymph node, and left posterior axillary lymph node enlargement, and no tenderness. Left cervical lymph node resection was performed for pathological examination. The lymph node structure was basically preserved, and subcapsular and medullary sinus structures were observed. Many histiocytes in the sinus were observed, the cortical area was reduced, a few lymphoid follicles of different sizes were observed, and some atrophy and hyperplasia were noted. The lymphoid tissue in the paracortical region of the lymph node was diffusely proliferative and enlarged, mainly comprising histiocytes with abundant cytoplasm, immunoblasts and numerous lymphocytes with slightly irregular, small- to medium-sized nuclei. Nuclear karyorrhexis was easily observed, showing a few nuclear debris and the “starry sky” phenomenon, accompanied by abundantly branching high endothelial small vessels with few scattered plasma cells and eosinophil infiltration. Lymphoid follicle immunophenotype with reactive proliferative changes was observed. Approximately 40% of the cells in the paracortical region were positive for Ki-67, and the histiocytes expressed CD68, CD163, and some expressed S-100, with the absence of myeloperoxidase. The immunoblasts expressed CD30 and CD20, not ALK or CD15. Background small- to medium-sized T cells expressed CD2, CD3, CD5, CD7, CD4, and CD8; the number of CD8-positive T cells was slightly predominant, and a small number of T cells expressed granzyme B and T-cell intracellular antigen 1. The patient received a comprehensive medical treatment after the operation, and her condition was stable without progression at the 11-month follow-up evaluation.ConclusionsThe pathological features of AOSD lymphadenopathy raises the awareness of AOSD among pathologists and clinicians and aids in the diagnosis and differential diagnosis of AOSD lymphadenopathy from other reactive lymphadenopathies (lupus lymphadenitis, etc.) and lymphomas.

Role of the Yersinia pseudotuberculosis Virulence Plasmid in Pathogen-Phagocyte Interactions in Mesenteric Lymph Nodes.

Yersinia pseudotuberculosis is an Enterobacteriaceae family member that is commonly transmitted by the fecal-oral route to cause infections. From the small intestine, Y. pseudotuberculosis can invade through Peyer's patches and lymph vessels to infect the mesenteric lymph nodes (MLNs). Infection of MLNs by Y. pseudotuberculosis results in the clinical presentation of mesenteric lymphadenitis. MLNs are important for immune responses to intestinal pathogens and microbiota in addition to their clinical relevance to Y. pseudotuberculosis infections. A characteristic of Y. pseudotuberculosis infection in MLNs is the formation of pyogranulomas. Pyogranulomas are composed of neutrophils, inflammatory monocytes, and lymphocytes surrounding extracellular microcolonies of Y. pseudotuberculosis. Key elements of the complex pathogen-host interaction in MLNs have been identified using mouse infection models. Y. pseudotuberculosis requires the virulence plasmid pYV to induce the formation of pyogranulomas in MLNs. The YadA adhesin and the Ysc-Yop type III secretion system (T3SS) are encoded on pYV. YadA mediates bacterial binding to host receptors, which engages the T3SS to preferentially translocate seven Yop effectors into phagocytes. The effectors promote pathogenesis by blocking innate immune defenses such as superoxide production, degranulation, and inflammasome activation, resulting in survival and growth of Y. pseudotuberculosis. On the other hand, certain effectors can trigger immune defenses in phagocytes. For example, YopJ triggers activation of caspase-8 and an apoptotic cell death response in monocytes within pyogranulomas that limits dissemination of Y. pseudotuberculosis from MLNs to the bloodstream. YopE can be processed as an antigen by phagocytes in MLNs, resulting in T and B cell responses to Y. pseudotuberculosis. Immune responses to Y. pseudotuberculosis in MLNs can also be detrimental to the host in the form of chronic lymphadenopathy. This review focuses on interactions between Y. pseudotuberculosis and phagocytes mediated by pYV that concurrently promote pathogenesis and host defense in MLNs. We propose that MLN pyogranulomas are immunological arenas in which opposing pYV-driven forces determine the outcome of infection in favor of the pathogen or host.

Continuing Education Needs Identified During the Initial Experience of Delivering 3D Conformal Radiotherapy for Cervical Cancer Patients in Tanzania

In resource-limited settings where experience with 3D conformal radiation therapy (3DCRT) is still growing, review of simulation CTs and radiation therapy plans may illuminate topics for continuing education. We conducted a review of an early cohort of cervical cancer patients treated with 3DCRT in Tanzania to identify education needs that may be generalizable to similar resource-limited settings.In Tanzania, 3DCRT capabilities began in August 2018. A retrospective review of 30 consecutive patients who received definitive whole pelvis 3DCRT for cervical cancer from 2019 to 2020 was conducted after IRB approval. Each patient's simulation CT was evaluated for evidence of advanced disease not detected on initial diagnostic work-up, including pelvic or para-aortic lymphadenopathy (LAD) defined as axial dimension > = 1 cm. An independent set of contours was generated according to United States national consensus guidelines. DICE similarity coefficient (DSC) agreement analysis was conducted between contours. As non-systematic variations in planning target volume (PTV) labelling, summations, and expansions precluded direct comparisons, only clinical target volume (CTV) contours were compared in this analysis. Clinically treated 3DCRT plans were evaluated using original and consensus-based contours, and dosimetric coverage was compared using Wilcoxon signed-rank testing.Simulation CT was the sole means of pre-treatment cross-sectional abdominopelvic imaging in 24/30 patients (80%). The pre-simulation clinical stages were FIGO IB (n = 6), IIA (n = 10), IIB (n = 12), IIIA (n = 1), and IVA (n = 1). Simulation CT upstaged 20 of 30 patients (66.7%) to IIIC1 or IIIC2 disease, identifying eight patients with para-aortic LAD and 13 patients with pelvic LAD. Agreement analysis between clinical and consensus-based contours revealed high agreement in the primary CTV (DSC median 0.83, IQR 0.68 - 0.87), bladder (0.93, IQR 0.88 - 0.95), and femur (0.86) contours, but lower agreement in lymph node CTV (CTVn) contours (DSC 0.59, IQR 0.46 - 0.67). The median volume of clinical-CTVn covered by 45 Gy was 99.7% (IQR 97.5 - 100) while the median volume of consensus-CTVn covered by 45 Gy was 83.3% (IQR 80.1 - 90.1) (P < 0.001). The most frequently undercovered regions were the superior and inferior pre-sacral nodal regions.In resource-limited settings, early case review after 3DCRT initiation may reveal key elements in radiation planning that can guide continuing education topics. In our setting, high yield interventions include systematic evaluation of pelvic and para-aortic LAD on simulation CTs, educational refreshers about nodal contouring, and development of resource-appropriate treatment paradigms when advanced nodal disease is detected.

Sarcoidosis is a multisystemic disease and its diagnostic difficulties

The peculiarities of the clinical symptoms of sarcoidosis and complexity of its diagnosis have been considered on the clinical example of sarcoidosis manifestations in a young man. Sarcoidosis is a relatively rare multisystem inflammatory granulomatous disease of unknown etiology. The incidence of sarcoidosis varies according to different authors from 7.5 to 64 cases per 100.000 population. The clinical manifestations of sarcoidosis are determined by the number of affected organs, the degree of their structural and functional disorders, and the severity of general inflammatory symptoms. Mostly often, the process involves the intrathoracic lymph nodes, lungs, skin and eyes. Musculoskeletal involvement is rare; about 10 — 15 % of patients with sarcoidosis have associated arthropathy. In this article, special attention is paid to the importance of assessing the articular syndrome and visualization of the chest cavity organs, as well as assessing the dynamics of changes in the progression of the disease. The dynamic changes in laboratory parameters and instrumental diagnostic methods have been highlighted. The analysis of the literature data about sarcoidosis was carried out. The emphasis is stroked on the limitations of modern diagnostic methods, as well as the non‑specificity of clinical manifestations. A doctor can only rely on the results of histological studies or imaging using computed tomography or nuclear magnetic resonance imaging. It is noted that the symptom complex, known as Löfgren’s syndrome, manifests with a combination of skin manifestations, hilar lymphadenopathy and articular syndrome, and is very rare. In the presented clinical case, medrol 16 mg per day was used as a basic therapy. Therapy with glucocorticosteroids was associated with a good clinical and laboratory response, a decrease in the size of the mediastinal neoplasm, and an improvement in the patient’s well‑being.&#x0D;

Mesenteric Lymphadenitis and Terminal Ileitis is Associated With Yersinia Infection: A Meta-analysis

Yersinia infection affects terminal ileum and lymph nodes and could therefore mimic the symptoms of appendicitis. We aimed to systematically characterise the suspected or confirmed abdominal diseases and/or surgeries associated with Yersinia infection. This systematic review and meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol (CRD42016053252) was uploaded to PROSPERO. The searches were conducted in PubMed and EMBASE on October 2,2020. Original reports on patients with abdominal surgical diseases were included. The primary outcome was to characterise suspected or confirmed abdominal surgical diseases and/or surgeries associated with Yersinia infection, while the secondary outcomes were the positive rate of Yersinia species for each disease and surgery, and to investigate the rate of Yersinia spp. in different geographic regions. We calculated the weighted mean prevalence of positive tests for Yersinia spp. for the different diseases and surgeries according to the detection method and for subgroups based on geographic region. From the search, 33 studies were included in the systematic review and 18 in the meta-analysis. Across geographic regions, the weighted mean prevalence for Yersinia spp. was 51% (95% CI 34%-69%) in mesenteric lymphadenitis, 65% (95% CI 45%-85%) in terminal ileitis, and 8% (95% CI 2%-15%) in normal appendices. Around half of the patients with mesenteric lymphadenitis and terminal ileitis were serologically positive for infections with Yersinia spp. Yersinia infection may cause unnecessary surgery for suspected appendicitis due to symptoms from mesenteric lymphadenitis or terminal ileitis.

Particularities of oro-maxillofacial surgical treatment for pregnant women

Pregnancy induces general changes that increase the susceptibility to diseases of the stomatognathic system, generating complications that can endanger the life of the mother and fetus. Purpose: Clinical-statistical evaluation of diseases in the oro-maxillo-facial region found in pregnant women, in order to increase the efficiency of diagnosis and surgical treatment. Data and methods: Have been studied 86 pregnant patients aged 17-40 years (mean 28.8 ± 2). Group 1, prospective study, ambulatory within the dental clinic “Omni Dent”, duration 1-year, clinical examination of 27 patients. Group 2, retrospective study, in the hospital, OMF surgery department of IMSP IMU, duration 6 years, 59 patients. Results: Group 1: consulted patients in trimesters: 1st — 5 (19.23%), 2nd — 11 (42.31% ), 3rd — 10 (38.46%). Diagnosis: pregnancy gingivitis — 8 (29.63%), caries — 7 (25.93%), pericoronitis — 4 (14.81%), root rot — 3 (11.11%). Group 2: treatment in the trimesters: 1st — 17 (28.81%), 2nd — 22 (37.29%) and 3rd — 20 (33.9%). The cause of infection, lower molars — 34 (82.92%), upper molars — 4 (9.76%), lower premolars — 3 (7.32%). Diagnosis: acute lymphadenitis — 7 (11.86%), pericoronitis — 17 (28.81%), and odontogenic abscess — 22 (37.29%) in the retromolar spaces — 12 (29%), subperiosteal — 9 (22%), the mandibulo-lingual groove- 7 (17%), submandibular5 (12%). Conclusion: Surgical treatment of dental diseases and their complications can be avoided by addressing patients in time.

Fine needle aspiration cytology as a diagnostic tool in superficial lyphadenopathy of pediatric age group

Background: Superficial Lymphadenopathy (LAP) is a common clinical presentation seen in pediatric patients attending the outpatient department. The etiology of Superficial LAP varies from a benign process to malignancy. Fine needle aspiration cytology (FNAC) is a very rapid and easy to perform diagnostic test. Majority of cases can be diagnosed and managed on FNAC without need of histopathology. The aim of this study was to evaluate the role of FNAC in diagnosis of superficial LAP in pediatric population. Methods: This retrospective study was carried out over a period of two year from June 2019 to May 2021 in the department of Pathology, B.J. Medical college, Civil Hospital Ahmedabad, Gujarat, India. Aspirated material was stained with Giemsa, Papanicolaou and Ziehl- Neelsen stain (whenever required). Distribution of cases in different age groups and sex was analyzed. lesions were categorized into benign and malignant conditions. All cases of superficial LAP seen in pediatric population where FNAC was performed were included in the study. Results: A total of 122 lymph nodes were aspirated in pediatric population during the study period. Majority of cases (94%) were benign. The results were categorized into two broad categories as benign- reactive lymphadenitis (67; 55%), Granulomatous lymphadenitis (47; 39%) and malignancy (08; 06%). The eight cases of malignancies identified in this population comprised of four cases, one of Hodgkin’s Lymphoma (HL) and three of Non-Hodgkin’s Lymphoma (NHL). In this study, maximum number of patients were in the age group of 10-14 years (46%) followed by

Reactive Axillary Lymphadenopathy to COVID-19 Vaccination on F-18-FDG PET/CT, F-18-Choline PET/CT and Ga-68 DOTATOC PET/CT Scans in Cancer Patients

Reactive Axillary Lymphadenopathy to COVID-19 Vaccination on F-18-FDG PET/CT, F-18-Choline PET/CT and Ga-68 DOTATOC PET/CT Scans in Cancer Patients

Rheumatoid Arthritis with Generalized Lymphadenopathy Mimicking Lymphoma on Positron Emission Tomography/Computed Tomography with 18F-Fluorodeoxyglucose.

A 42-year-old male presented with weight loss and progressively increasing pain and swelling in joints over the past 3 months. Contrast-enhanced computed tomography (CT) demonstrated pleuropulmonary opacities and supra/infradiaphragmatic lymph nodes enlargement. Positron emission tomography (PET/CT) with 18F-fluorodeoxyglucose showed intensely increased tracer uptake in joints, in pulmonary opacities, as well as in thoracic, iliac, and inguinal nodes. On suspicion of lymphoma with synovial involvement, he was submitted to lymph node and synovial biopsy, which revealed reactive follicular lymphadenopathy and synovium inflammatory changes, respectively. Rheumatoid factor resulted increased, and thus, diagnosis of rheumatoid arthritis with related lung and lymph node involvement was made.

Hematological and biochemical features with tuberculosis and bacterial lymphadenitis in children

Objective — to improve approaches to differential diagnosis of lymphadenitis by identifying features of hematological and biochemical parameters of blood of children with nonspecific bacterial and specific tuberculous lymphadenitis.&#x0D; Materials and methods. Under our supervision were 45 children aged 1 to 5 years with an increase in lymph nodes (LN), who were treated in the surgical department of the Odessa Regional Children’s Clinical Hospital for the period from 2017 to 2018. Patients were assessed for general condition and affected lymph node lesions, as well as blood sampling for general and biochemical studies. Additionally, the calculation of integrated hematological indices of immunological tolerance of the organism was performed, namely the index of neutrophils to lymphocytes ratio (NLR); lymphocyte to monocyte ratio (LMR); neutrophil to monocyte ratio (NMR); lymphocyte to eosinophil ratio (LER). For comparison with the norm used the data of these indicators, established in healthy children.&#x0D; Results and discussion. All patients were divided into 2 clinical groups. The first group (СG-1) included 25 children with lymphadenitis caused by BCG vaccination, the second (СG-2) — 20 patients with acute purulent lymphadenitis. The study found that the condition of most children (75 %) of the second group was more severe compared with patients with CG-1, which was manifested by more pronounced manifestations of intoxication and local condition of the affected LN.Evaluation of a general blood test showed that the average number of leukocytes with specific lymphadenitis in most (80.8 %) patients was within normal limits, with purulent; on the contrary, in 71.4 % of children there was a tendency to increase. The calculations of hematological indices revealed a decrease in NLR, and, with BCG lymphadenitis, it decreased by half (to 0.96) compared with bacterial lymphade­nit (to 1.88), which indicates an increase in specific immunological reactivity in children of CG-1. ISNM in most patients with lymphadenit remained low throughout the course of the disease. This indicates the timely activation of the macrophage defense system of the body. LMR with tuberculous lymphadenit grew, while with bacterial lymphadenit, on the contrary, it decreased by half, which indicates earlier mobilization of lymphocytes as an effector immunity in children with BCG lymphadenitis. LER in all forms of the disease tended to increase, which indicates the predominance of a delayed-type hypersensitivity reaction in children of both groups.Analysis of blood biochemical parameters in patients of both clinical groups did not reveal clear differences in children with bacterial and tuberculous lymphadenitis.&#x0D; Conclusions. At specific defeat of LN unlike nonspecific, the clinical and laboratory picture with lack of expressive leukocytes reaction is noted. Determining the indices of the ratio of blood leukocytes makes it possible to more deeply assess the level of immunological reactivity and the general condition of the child, which increases the informative value of clinical blood tests. Analysis of blood biochemical parameters in patients with specific and nonspecific lymphadenitis, although it has no specific differential diagnostic value, however, is an important component of assessing the quality of treatment and the patient’s condition as a whole.

Cytological evaluation of cervical lymphadenopathy in a tertiary care centre, Govt. Medical College Kathua: Two year study

FNAC is a well-established, reliable, quick and minimally invasive method of diagnosis in palpable masses at various sites. In developing countries like India where tuberculosis is the commonest cause of lymphadenopathy, FNAC becomes much more important tool in diagnosing the cervical lymph nodes. The present study was carried out to describe the cytomorphological patterns of cervical lymph nodes and its utility in establishing a diagnosis. All lymph node aspirates done in cytology laboratory of our department over a period of two years [September 2019 to August 2021] were included in the study. Of the total 169 cases, 68 were diagnosed as non- specific reactive lymphadenitis, 38 tubercular lymphadenitis, 23 as metastatic carcinoma, 22 acute suppurative lymphadenitis, 08 granulomatous lymphadenitis, 6 non-Hodgkins lymphoma, 01 each case of Hodgkins lymphoma, Langerhans cell histiocytosis, Kimuras disease & Rosai Dorfman disease. Fine needle aspiration can be used as first line of investigation for evaluating patients with lymphadenopathy which has proven clinical value, diagnostic accuracy, sensitivity & specificity.