Node Swelling Research Articles

A Case with Rectal Cancer Relapses After Clinical Complete Remission Following Neoadjuvant Chemoradiotherapy

Despite advancements in diagnosis and therapy, relapse of rectal cancer after clinical complete remission (cCR) remains a frequent event. The key factors influencing the treatment strategy for the management of patients achieving cCR following neoadjuvant chemoradiotherapy (Neo-CRT) remain to be identified. We present the case of a 64-year-old man with rectal cancer. The patient was initially admitted to the hospital in September 2011 with a 3-month history of change in his stools. Following his re-hospitalization in November 2011, a biopsy specimen of the neoplasm suggested the presence of rectal adenocarcinoma; laboratory investigations also revealed elevated levels of carcinoembryonic antigens (CEA; carbohydrate antigen 199) in the serum. Subsequently, the patient received Neo-CRT, as well as symptomatic and supportive treatment. The level of serum CEA returned to normal, without signs of swollen lymph nodes in the pelvic cavity. The patient was diagnosed with rectal cancer based on the elevated level of serum CEA, colonoscopy, and contrast-enhanced magnetic resonance imaging. He relapsed 4 months after cCR following Neo-CRT and underwent laparoscopic Miles’ surgery in April 2013. The relapse may have been mainly attributed to residual tumor cells. This case report and literature review may contribute to the clinical recognition of treatment for patients with rectal cancer achieving cCR following Neo-CRT.

Transanal total mesorectal excision of giant villous tumor of the lower rectum with McKittrick\u2013Wheelock syndrome: a case report of a novel surgical approach

BackgroundMcKittrick–Wheelock syndrome (MKWS) is caused by a villous tumor of the rectosigmoid colon with hypersecretion of mucus containing electrolytes. Complete resection of the tumor is needed to cure this disease. Transanal total mesorectal excision (TaTME) is currently a promising treatment for lower rectal tumor because of the reliability of its resection margin especially in bulky tumor. We present this first case report of a TaTME for MKWS with a lower rectal tumor.Case presentationAn 81-year-old woman was admitted to our hospital with diarrhea and acute renal failure. Computed tomography and magnetic resonance imaging examinations revealed an 80-mm-sized enhanced tumor located in her lower rectum without lymph node swelling and distant metastasis. A giant villous tumor secreting mucus was seen in the lower rectum to the anal canal during colonoscopy. The result of tumor biopsy was adenocarcinoma. To preserve the anal function and ensure distal margin, we chose TaTME for curative resection. After improving the electrolyte imbalance, TaTME was performed successfully and R0 resection was achieved. There was no sign of recurrence or electrolyte depletion for 1 year after the surgery.ConclusionTaTME could be a promising surgical approach for giant villous tumor with MKWS in the lower rectum.

Peripheral T cell lymphoma not otherwise specified induced by fingolimod treatment for multiple sclerosis

Abstract Introduction Fingolimod is a sphingosine-1-phosphate (S1P) receptor modulator that prevents B and T lymphocyte egress from the lymph nodes, and reduces peripheral lymphocyte counts and entry of lymphocytes into the central nervous system. In 2010, the Food and Drug Administration (FDA) approved it for the treatment of relapsing-remitting multiple sclerosis (MS). It has been reported that Fingolimod treatment causes cutaneous side-effects such as opportunistic skin infections and cutaneous malignancies. We herein report the first case of peripheral T cell lymphoma, not otherwise specified (PTCL-NOS) induced by Fingolimod. Case report A 63-year-old man was diagnosed with MS at 33 years of age. Due to repeated MS relapses, the administration of Fingolimod was started at 61 years of age. After 2 years, skin rash appeared in the abdominal and right femoral regions. Computed tomography showed swelling of the left cervical, mesenteric and bilateral inguinal lymph nodes and cutaneous tumors in the abdominal and right femoral regions. He was diagnosed with PTCL-NOS based on biopsies of the skin in right femoral region and right inguinal lymph nodes. Immunohistochemistry was positive for CD3, CD4, CD5, CD7, and negative for CD8, CD25 and CD30. He was treated with methylprednisolone (500 mg/day) for 3 days followed by prednisolone. His skin tumors and lymph node swelling did not progress. Discussion Among 10 reported cases of malignant lymphoma induced by fingolimod, 7 had a T-cell lineage and 8 cases occurred in the cutaneous region. Fingolimod should be stopped if lymphomatous lesions are found. However, the treatment of the MS patients with lymphoma is very troublesome. There are few alternatives to fingolimod for the treatment of relapsing MS. Additionally, the performance status of the patients with relapsing MS is not usually good enough to undergo standard therapies. Further analyses are required to reveal the lymphomagenesis in patients undergoing fingolimod treatment.

A CURIOUS CASE OF MYOCARDITIS WITH ELEVATED ANTISTREPTOLYSIN O TITERS

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Acute rheumatic fever can cause a spectrum of rheumatic heart disease, including myositis, pericarditis, or valvulitis. It is mostly seen in children and is considered a disease of poverty. Here, we present a case of a 24 year-old with myocarditis secondary to rheumatic fever. CASE PRESENTATION: A 24 year-old male presented to the emergency department because of chest pain that started 2 nights prior. His pain was rated 8/10, nonradiating, worse with inspiration and associated with nausea. It was the first time he had experienced chest pain. The patient was recently discharged from the the hospital because of acute tonsillitis, where he experienced throat pain, fever, nausea, vomiting, cervical and submandibular lymph node swelling. He was discharged with improvement of his tonsillitis after treatment with clindamycin. He has no significant past medical history. On physical examination, the patient’s temperature was 38.2*C and heart rate was 103 bpm with the rest of physical examination being unremarkable. Chest X-ray showed bilateral pulmonary congestion with cardiomegaly but no infiltrates or consolidation. EKG revealed diffuse ST segment depression. Laboratory studies showed an elevated white count with normal neutrophil and lymphocyte counts. Troponin levels were elevated from 0.359 ng/mL and peaked to 0.447 ng/mL. Urine toxicology was negative. Blood cultures were taken but returned negative. He was admitted to the telemetry unit with elevated troponin levels to rule out acute coronary syndrome. Cardiology performed an echocardiogram, showing no structural or functional abnormalities; a cardiac catheterization showed the patient had nonobstructive CAD. Throughout his hospital stay, he had fluctuating temperatures, with a Tmax of 38.9*C and developed right knee pain and then pain in the left knee two days later. X-rays were taken of both knees, demonstrating moderate effusion of the right knee. Infectious disease was consulted and recommended ASO titers, influenza Ag, stool culture, and gonorrhea and chlamydia urine PCR. All results of the laboratory test were negative except for the ASO titer of 1:200, CRP of 309.1 mg/dL, and ESR of 114 mm/hr. He was started on naproxen as well as benzathine penicillin G with a diagnosis of myocarditis secondary to rheumatic fever. The patient showed much improvement throughout the course of hospital stay and was discharged to follow up with cardiology and infectious disease clinics. DISCUSSION: The differential diagnosis for a young adult with chest pain is usually secondary to drugs or chest wall pain. It is very unusual for a young adult to present with myocarditis secondary to rheumatic fever, which is more commonly seen in children. It is pertinent to consider acute myocarditis associated with GAS tonsillitis as a differential. CONCLUSIONS: An early diagnosis and treatment can significantly improve the prognosis of the patients. Reference #1: Jose L. Aguirre, MD, Margarita Jurado, MD, Mateo Porres-Aguilar, MD, Cristina Olivas-Chacon, MD, Mateo Porres-Muñoz, MD, Debabrata Mukherjee, MD, and  Juan Taveras, MD. Acute nonrheumatic streptococcal myocarditis resembling ST-elevation acute myocardial infarction in a young patient. DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response No relevant relationships by Hung-I Liao, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Neuro-ophthalmological manifestations of POEMS syndrome

The cases is presented of a 38 year-old male with a constitutional syndrome, fever, multiple swollen lymph nodes, and hepatosplenomegaly of 2 months onset. There was also mention of headache, bilateral blurred vision, and myiodesopsias. Best correct visual acuity was 20/50 and 20/200. The anterior segment was unremarkable. The fundus of both eyes showed raised and erased discs, accompanied by serous detachment, greater in the left eye. Complementary studies of both eyes showed a visual field with increased blind spot; fluorescein angiography indicated late disc hyperfluorescence. The electroretinogram showed compromise of cones and rods, and the visual evoked potential detected alteration in the perception and conduction of stimuli. The imaging studies were essentially normal. During his hospital admission he presented with paraparesis, renal failure, endocrinopathy, skin alterations, and osteoblastic lesions with negative biopsies. Monoclonal gammopathy was documented, and the diagnosis of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome was made. The chemotherapy started with dexamethasone/melphalan, with a good response at 3 months.

Diagnosis Penyakit Rubella Menggunakan Metode Fuzzy Tsukamoto

Rubella or better known as German measles is a viral infection characterized by a red rash on the skin. Lack of general public understanding of this disease makes the number of patients with Rubella increasing. So Fuzzy Tsukamoto's method is used to detect Rubella disease. The purpose of this study is to facilitate the public in understanding about Rubella disease so as to reduce the number of sufferers of this disease. The first step to detecting Rubella disease is to determine the fuzzy set and the domain which includes 3 variables: red rash, swollen lymph nodes, and fever. The output of fuzzy calculations is someone experiencing Rubella or normal symptoms. The value obtained from the calculation process usig the Tsukamoto method is 6.00.

CLINICAL AND PATHOLOGICAL STUDY OF THEILERIOSIS IN CATTLE AND BUFFALOES IN AL-GHANIEM REGION, ASSIUT GOVERNORATE, UPPER-EGYPT

A detailed Clinico-pathological profile of clinically diseased cattle and buffaloes with Theileriosis located in Al-Ghaniem region, Assiut Governorate, was aimed. Theileria annulata was confirmed by the presence of T. annulata piroplasms in blood smears and/or lymph smears followed by polymerase chain reaction (PCR). During the period of investigation (April 2015 to August 2018), out of the clinically inspected cattle (n= 300) and buffaloes (n= 100), 80 (26.67%) and 15 (15 %) cases were clinically suspected to have Theileriosis, respectively. The positive cases were molecularly identified (PCR). The general observed signs were anorexia, fever, swelling of superficial lymph nodes. ocular lesions were white cloudiness were more obvious in the center of cornea rather than the borders (yellowish colored corneoscleral opacity surrounded by hyperemic band). a watery discharge from the eyes. Serous ocular discharge (watery lacrimation) was remarkable, however in severe cases the ocular discharges was accumulated in the medial canthus. Some newly born calves of less than one month exposed to ocular symptoms mainly protruding of eye ball with ictric conjunctiva. The clinical examination of conjunctivae of the clinically suspected cases with Theileriosis indicated that icteric appearance of conjunctivae in some cases. Three cases showed petechiated conjunctivae. In our study some animals showed up--word visible bulging of temporal fossa. visible protrusion of hemorrhagic conjunctiva with apparently exophthalmia (ocular edema) were observed. Bloody diarrhea and tarry like diarrhea, change in feeding behavior or habit like depraved appetite by eating mud ,soil were noticed. On the other side, the most prominent necropsy features the recently succumbed animals: Gross changes in various organs including heart lungs, trachea, stomach, liver, spleen, kidneys superficial lymph nodes, mesenteric lymph nodes, small and large intestine. All mucous membranes and conjunctivae, peritoneum and abdominal fatty tissues were icteric. On external observation. Jaundice, petechial hemorrhages involving mucosal and serosal surfaces of many organs as well as body fat. In the thoracic cavity, the most prominent autopsy findings were obviously extra edematous swelling of all lobes of the lung, hydrothorax and the lung was distended, discolored, solid in texture, and filled with exudate by palpation, The liver was friable, yellowish, and larger than normal, with the gall bladder being markedly distended with dark olive-green or brownish green bile. The abomasum was the most severely affected organ in the alimentary canal, it contains numerous ulcers about 3 mm. in diameter .a few linear ulcers were present on the leaves. There were prominent hemorrhagic ulcers and petechial hemorrhages were seen in the abomasum of the most cases. There were remarkable enlargement of spleen (splenomegaly) were also recorded. The kidneys were congested or dark brown in color and their perirenal fat were yellowish in color. The heart had petechial and hemorrhages on the outer and inner surface of the auricles.

An outbreak of skin rash traced to a portable floating tank in Norway, May 2017.

Despite concerns about infection risks of floating tanks, outbreaks have rarely been reported. In May 2017, an outbreak of skin rash occurred among visitors of a floating tank open for the public in Norway. We assessed the extent and cause of the outbreak and the risk factors for infection in a retrospective cohort study among the visitors of the floating tank using a standardized web-based questionnaire. An environmental investigation was conducted including microbiological analysis of the floating tank water. Of the 46 respondents to the questionnaire (61 distributed), 22 reported symptoms, most commonly palmar and plantar rash, swollen lymph nodes, ear canal pain and itching. None of the investigated risk factors, such as sex, age, duration of bathing or use of the shower after bathing, were significantly associated with illness. The results of the environmental investigation indicated that the water was heavily contaminated by P. aeruginosa and heterotrophic bacteria. The outbreak investigation highlights the need to ensure adequate hygienic operation of floating tanks. Awareness about responsibilities should be raised among the operators of floating tanks and relevant operational parameters for floating tanks should be made available for local health authorities.

Diagnosa Penyakit Rubella Menggunakan Metode Fuzzy Tsukamoto

Rubella or better known as German measles is a viral infection characterized by a red rash on the skin. Lack of general public understanding of this disease makes the number of patients with Rubella increasing. So Fuzzy Tsukamoto's method is used to detect Rubella disease. The purpose of this study is to facilitate the public in understanding about Rubella disease so as to reduce the number of sufferers of this disease. The first step to detecting Rubella disease is to determine the fuzzy set and the domain which includes 3 variables: red rash, swollen lymph nodes, and fever. The output of fuzzy calculations is someone experiencing Rubella or normal symptoms. The value obtained from the calculation process usig the Tsukamoto method is 6.00.

A case of secondary syphilis presenting on the oral mucosa: A case report

AbstractSyphilis is a sexually transmitted disease caused by Treponema pallidum. We report a case of secondary syphilis originating in the oral mucosa. The patient was a 58‐year‐old man who visited our hospital at May 2009. Clinical examination revealed a mass at the right angle of the mouth with a white mass on the tip of the tongue and an indurated ulcer on the left border of the tongue. Magnetic resonance imaging revealed multiple swollen lymph nodes in the bilateral submandibular glands, as well as in the bilateral deep cervical and supraclavicular lymph nodes. Serological examination revealed elevated rapid plasma reagin (RPR) (titer, 1:32) and Fluorescent treponemal antibody absorption test (2+) values. Consequently, the mass at the right angle of the mouth, the white patch on the tip of the tongue, and the ulcer on the left border of the tongue were diagnosed as secondary syphilis. Oral amoxicillin 1500 mg/d was administered for 4 weeks. The oral lesions improved after 20 days of treatment and the RPR titer had improved to 1:2 after 5 months of treatment.

Role of staging laparoscopy for gastric cancer patients.

Staging laparoscopy (SL) is frequently carried out in patients with advanced gastric cancer. However, some clinical questions are being debated and consensus must be obtained. With this aim, a literature search of PubMed/MEDLINE was carried out using the keywords “gastric cancer,” “SL,” and “diagnostic laparoscopy”. Articles published online up to February 2019 were analyzed, focusing on the following questions. (i) What is an adequate indication for SL? (ii) How do you carry out SL? (iii) Does SL provide accurate information about peritoneal dissemination? (iv) Is the yield of SL different by tumor location? (v) Is SL a safe procedure? (vi) Is “repeat SL” needed? (vii) Does SL provide oncological benefit? Results provided the following responses: (i) In Western countries, clinically resectable advanced tumor is an indication for SL. Terms to be introduced for adequate indication include “location,” “type 4 (linitis feature),” “large tumor,” “equivocal computed tomography (CT] findings,” and “lymph node swelling”. (ii) Exploration of the entire peritoneal cavity is preferable. (iii) Detection rate of peritoneal disease is 43%‐52% in Japanese institutions and 7.8%‐40% in other countries. False‐negative findings during SL were 0%‐17%, and 10%‐13% when limited to cytology. (iv) Yield of SL was higher in gastric cancer compared with esophagogastric junctional tumor. (v) SL‐related complications were estimated to occur in 0.4%. (vi) Repeat SL is important after treatment. (vii) If the efficacy of neoadjuvant chemotherapy for patients with P0CY1 is established, SL can provide oncological benefit. SL can be carried out safely and effectively. Considering the prevalence of neoadjuvant treatment, the role of SL will become more important.

Lymph node abscess caused by Francisella tularensis \u2013 a rare differential diagnosis for cervical lymph node swelling: a case report

BackgroundCervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked. With an incidence of 120 cases in the United States of America (USA) and approximately 25 cases in Germany per year, infection with the pathogen Francisella tularensis is one of these rare diseases that can cause massive lymph node swellings and might even be fatal.Case presentationThe example of a healthy 67-year-old German woman who was treated at our university hospital presents a typical progression of a localized form of tularemia. The pathogen could be identified in a universal 16S ribosomal deoxyribonucleic acid (DNA) polymerase chain reaction. Pathogen-specific treatment with lymph node abscess incision, daily rinsing of the abscess cavity, and orally administered antibiotic therapy with doxycycline could cure our patient completely without any remaining complications.ConclusionIn patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment. Possible infections with atypical bacteria like Francisella tularensis should never be ignored. Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens.

Mediastinal lymph node staging for lung cancer.

Mediastinal lymph node staging is crucial in deciding the treatment strategy for lung carcinoma. The diagnosis rate of computed tomography is not high; however, it is a standard examination. Although the contrast computed tomography is necessary for an accurate diagnosis, images from the positron emission tomography are excellent, and these two technologies are independent and complementary. Positron emission tomography has a disadvantage of false positives and false negatives, but it should also be used in cases where lymph node diameters are 1 cm or more. However, image-based diagnostic methods are not an alternative to histological examination. The results of a transbronchial needle biopsy are extremely dependent on the inspection method, the diagnostic ability of the physician, and the staging of the case. The transesophageal ultrasound endoscope is useful for reaching parts inaccessible by a mediastinoscope. Although its employment requires technical training, it is becoming popular as a minimally invasive method of obtaining cell and the tissue samples. A thoracoscopic biopsy is considered as a last resort for mediastinal lymph node diagnosis. Carefully-chosen invasive procedures are necessary to diagnose swollen lymph nodes. Although mediastinoscopy is still considered as the gold standard, most procedures will be replaced by a comparatively minimally invasive method in the future.

Endoscopic ultrasound-guided fine-needle aspiration biopsy - Recent topics and technical tips.

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.

Identification of Axillary Lymph Node Metastasis in Patients With Breast Cancer Using Dual-Phase FDG PET/CT

OBJECTIVE. The aim of this study was to assess the diagnostic performance of dual-phase 18F-FDG PET/CT in detecting axillary lymph node metastasis in patients with breast cancer. MATERIALS AND METHODS. A total of 826 patients with breast cancer were retrospectively evaluated. PET/CT scans were performed 1 hour and 2 hours after FDG administration before treatment. The maximum standardized uptake value (SUVmax) in the axillary lymph node at both time points (hereafter referred to as SUVmax1 and SUVmax2, respectively) and the retention index (RI) were calculated. RESULTS. Axillary lymph node metastasis was detected in 285 of 826 patients (34.5%). The median axillary SUVmax1, SUVmax2, and RI in patients with nodal metastasis were higher than those in patients without metastasis (1.5 vs 0.6, 1.6 vs 0.5, and 7.7 vs -3.7, respectively; all p < 0.001). The diagnostic accuracy of axillary SUVmax1 and SUVmax2 was equivalent, and the sensitivity and specificity of SUVmax1 were 74.7% and 83.4%, respectively. Although the performance of the axillary RI was inferior to that of SUVmax1 and SUVmax2, both the SUVmax and the RI were independent predictors of nodal metastasis, and a positive RI suggested axillary lymph node involvement when the SUVmax1 was significantly high. Of 533 patients with category T1-2 breast cancer without lymph node swelling, 101 (19.0%) had pathologic lymph node involvement; the negative predictive value of axillary SUVmax1 was 86.8%. CONCLUSION. Delayed phase imaging identified axillary lymph node metastasis as accurately as standard PET/CT. A high negative predictive value of PET/CT for the detection of nodal metastasis is helpful to avoid surgical axillary assessment in patients with category T1-2 breast cancer without lymph node swelling.

Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

Background: Drug-resistant tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in particular represent a major threat to the fight against tuberculosis globally. MDR-TB presents with similar features and is transmitted in the same way as drug sensitive TB but its progression is rapid and its treatment, associated drug toxicity and monitoring constitute a heavy burden to the patients and the health system. MDR-TB affect people of all age groups but very little is known about the magnitude of this problem in children.&#x0D; Aims/Objectives: To determine the prevalence of multidrug resistant tuberculosis among children in Port Harcourt.&#x0D; Materials and Methods: Information on Paediatric tuberculosis was retrieved from the patients’ case notes, TB registers at the directly observed treatment short course (DOTs) clinic and the Multidrug resistant tuberculosis (MDR-TB) treatment center of the University of Port Harcourt Teaching Hospital from January 2018 to June 2019. Obtained data was analysed and presented in prose and tables. &#x0D; Results: There was a total of 1,860 patients records of which 37 were Paediatrics cases giving a prevalence of Paediatric tuberculosis cases of 2.0% Out of these 37cases, four were multidrug resistant tuberculosis cases giving a prevalence of MDR-TB cases of 10.8%. There were three males and one female giving a male female ratio of 3: 1. and their ages ranged from 3months to 24months. All belonged to social class 5. Common presentation was chronic cough, prolonged fever, weight loss and lymph node swellings. Three (75%) had no prior treatment for tuberculosis while one (25%) completed 6months of anti TB drugs. All had BCG immunization within one week of delivery. One (25%) child had extra-pulmonary TB while 3(75%) children had pulmonary tuberculosis. Xpert MTB/RIF assay for all (100%) showed MTB detected, RIF resistant detected. Three (75%) of the mothers had MDRTB and the medications for their children was based on the drug sensitivity testing (DST) of their mothers. One (25%) of the children and his mother were HIV positive and the mother had died while still on the intensive phase of second line antiTB drugs. Three (75%) had completed the intensive phase of the conventional therapy with second line antiTB drugs and are closely followed up weekly on the continuation phase while one child is still on admission.&#x0D; Conclusions: The prevalence of MDR-TB in children in PH is high. All childhood TB (whether drug susceptible or drug resistant) is usually traced to an adult, thus effectively diagnosing and treating all adults as well as a high index of suspicion in presumptive cases is required to curb MDR-TB.&#x0D; Recommendations: We recommend strict use of the DOTs strategy in TB management to ensure drug adherence. Also, proper contact tracing, investigation and treatment of children of infected parents to reduce cases of MDR-TB is advocated.

Manifestaciones neurooftalmológicas del síndrome de POEMS

The cases is presented of a 38 year-old male with a constitutional syndrome, fever, multiple swollen lymph nodes, and hepatosplenomegaly of 2 months onset. There was also mention of headache, bilateral blurred vision, and myiodesopsias. Best correct visual acuity was 20/50 and 20/200. The anterior segment was unremarkable. The fundus of both eyes showed raised and erased discs, accompanied by serous detachment, greater in the left eye. Complementary studies of both eyes showed a visual field with increased blind spot; fluorescein angiography indicated late disc hyperfluorescence. The electroretinogram showed compromise of cones and rods, and the visual evoked potential detected alteration in the perception and conduction of stimuli. The imaging studies were essentially normal. During his hospital admission he presented with paraparesis, renal failure, endocrinopathy, skin alterations, and osteoblastic lesions with negative biopsies. Monoclonal gammopathy was documented, and the diagnosis of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome was made. The chemotherapy started with dexamethasone/melphalan, with a good response at 3 months.

A lung abscess caused by secondary syphilis \u2013 the utility of polymerase chain reaction techniques in transbronchial biopsy: a case report

BackgroundIn Japan and other countries, the number of patients with syphilis is increasing year by year. Recently, the cases of the pulmonary involvement in patients with secondary syphilis have been reported. However, it is still undetermined how to obtain a desirable specimen for a diagnosis of the pulmonary involvement, and how to treat it if not cured.Case presentationA 34-year-old man presented with cough and swelling of the right inguinal nodes. A physical examination revealed erythematous papular rash over the palms, soles and abdomen. A 4 cm mass in the right lower lobe of the lung was detected on computed tomography. He was diagnosed as having secondary syphilis, because he was tested positive for the rapid plasma reagin and Treponema pallidum hemagglutination assay. Amoxycillin and probenecid were orally administered for 2 weeks. Subsequently, rash and serological markers were improved, however, the lung mass remained unchanged in size. Transbronchial biopsy (TBB) confirmed the pulmonary involvement of syphilis using polymerase chain reaction techniques (tpp47- and polA-PCR). Furthermore, following surgical resection revealed the lung mass to be an abscess.ConclusionsTo our knowledge, this is the first surgically treated case of a lung abscess caused by syphilis, which was diagnosed by PCR techniques in TBB. This report could propose a useful diagnostic method for the pulmonary involvement of syphilis.

A prospective study on clinicopathological study of cervical lymphadenopathy

Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. This study was done to know the correlation between clinical presentation of FNAC and histopathology of cervical lymphadenopathy, to emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in cervical lymphadenopathy. 50 patients with cervical lymphadenopathy were assessed clinically, by laboratory and by FNAC study over a period of two years. In the present study, results revealed that tuberculous lymphadenopathy is the commonest cause of cervical lymphadenopathy with 68% followed by chronic non-specific lymphadenopathy with 32. Of the 35 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 50 had subsequent surgery and histological confirmation of the cytological appearance. 34 had TBLN (Tuberculous Lymphadenopathy), thus the specificity of FNAC was 94 per cent in diagnosing tuberculosis related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be non specificity. Present study had cervical lymph node swelling. Other common presenting symptoms were loss of weight and loss of appetite (20%), fever (30%), axillary and inguinal swellings (4%), cold abscesses (8%), pain (6%), sore throat, cough, discharging sinus, old sinus scars, caries tooth (2%). there was only unilateral involvement of node in 72% of cases right side was affected in 32% and left side was affected in 40% of cases bilateral involvement was seen in 14% of the cases. The lymph nodes were associated with other groups of lymph nodes in 10% of cases. In our study the sensitivity and specificity of FNAC of tuberculous cervical lymphadenopathy is 77 and 94 respectively. The results concluded that tuberculosis is the most common cause of cervical lymphadenopathy in the Indian population followed by reactive lymphadenitis and metastatic deposits. Reactive lymphadenitis is the commonest cause of cervical lymph node enlargement in different age group, infective in 11-40 yrs. age group including tuberculous and suppurative lymphadenitis, neoplastic lesions in more than 40 age group including metastatic disease and nonhodgkins lymphomas. FNAC is an important diagnostic modality for the etiologic workup in significant cervical lymphadenopathy and is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.

Clinicopathological evaluation of benign neck masses with emphasis on correlation of preoperative ultrasound and cytology with postoperative histopathology in tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Benign neck mass is a common clinical condition which an ENT clinician routinely encounters. Commonly presenting benign neck masses occur within lymph nodes, thyroid, parotid and other salivary glands. Less common pathologies presenting as neck swellings are from thyroglossal cysts, branchial cleft cysts, carotid body tumors, cystic hygromas, pharyngeal pouch abnormalities and lumps of skin appendages.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is prospective observational based study. Duration of study is 1 yr 6 months. All palpable neck masses which are clinically diagnosed as benign were selected.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Study was conducted in Shri Vasantrao Naik Government Medical college, Yavatmal of 123 patients out of which 84 were thyroid swellings, 18 were salivary gland swellings and 21 were other swellings out of which 9 were lymph node swellings. 80.48% were female patients and 19.51% were male patients. Maximum number of patients were between the age group 31-40 years (28.45%) followed by 26.05% in 41-50 years. This is 1yr 6months observational study of epidemiological and clinicopathological spectrum and outcome of management of benign neck masses. This study also determines the histopathological correlation and accuracy of FNAC in the diagnosis of benign neck masses.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude from present study, that fine needle aspiration cytology is a safe, simple and more accurate than USG that can be done in diagnosing wide range of neck swellings. Probably USG guided fine needle aspiration cytology will be better investigation one can ask for. However confirmatory and accurate diagnosis is given by histopathology.&lt;/p&gt;