Nonspecific Lymphadenopathy Research Articles

Exploring the Spectrum of Lymphadenopathy: Insights From a Three-Year Fine Needle Aspiration Cytology Study in a Tertiary Care Center.

Introduction Lymphadenopathy, characterized by the enlargement of lymph nodes, is a common concern encountered by physicians in outpatient settings. It is deemed significant and warrants evaluation due to the diverse range of potential causes, ranging from treatable infections to incurable metastatic malignancies. Fine needle aspiration cytology (FNAC) emerges as a crucial tool in addressing these concerns, acknowledged for its rapid diagnostic capabilities, simplicity, accuracy, and minimal invasiveness. Objectives This retrospective study aims to characterize the spectrum of lymphadenopathy cases observed in a tertiary care center over a specified period, shedding light on the prevalence, etiology, and clinical outcomes associated with this condition. Methods Electronic medical records of patients presenting with lymphadenopathy to the tertiary care center between May 2021 and June 2023 were reviewed. Data on patient demographics, clinical presentation, imaging findings, and cytopathological and histopathological diagnoses were analyzed. Results A total of 300 cases of lymphadenopathy were identified during the study period. The study population exhibited a diverse range of age groups, with a slight predilection for the age range of 11-20 years. The most common sites of lymphadenopathy were in the cervical group, and the predominant clinical presentations included tender lymph nodes and fever. Etiologically, infectious causes, such as accounted for the majority of cases, followed by inflammatory and neoplastic etiologies. Notably, 2.6 % of cases presented with non-specific lymphadenopathy, warranting further investigation. Diagnostic modalities, including imaging studies and histopathological examinations, played a crucial role in establishing accurate diagnoses. The study also highlights the challenges in differentiating benign from malignant lymphadenopathy, emphasizing the need for a comprehensive diagnostic approach. Conclusion This study provides a comprehensive overview of the lymphadenopathy spectrum in a tertiary care center, emphasizing the importance of a multidisciplinary approach for accurate diagnosis and management. The findings contribute to our understanding of the epidemiology and etiological patterns of lymphadenopathy, guiding clinicians in optimizing patient care and outcomes in a tertiary healthcare setting.

Toxoplasmosis lymphadenopathy-A series of 8 cases diagnosed in a 2-year timeframe: Is it a needle in a haystack?

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an obligate intracellular parasite. Clinical presentation of infection depends on the age and immune status of the patient. In immunocompetent patient, it may present as a non-specific lymphadenopathy and self- limiting illness. In contrast, in immunocompromised patients it can be a life-threatening infection. We present a series of 8 cases of toxoplasma lymphadenitis diagnosed in our institute in last two years. Lymphadenopathy raises a suspicion of malignancy; however, diagnosis of reactive lymphadenitis often marks the end of diagnostic evaluation. Careful morphological evaluation, the classic triad, often can direct at a conclusive diagnosis. We are presenting a case series to draw attention to this entity as majority of the published literature is in the form of case report and serological surveys and very occasional study showing both the histopathology and serology in tandem.

Dual hemoglobinopathy presenting as lymphadenopathy: A diagnostic challenge

Abstract: Hemoglobinopathies, including sickle cell disease and beta-thalassemia, are genetic disorders that can manifest with diverse clinical presentations. Recognizing variations in hematological profiles is crucial for accurate diagnosis and management, particularly in regions where certain hemoglobinopathies are not so prevalent such as in regions of North India. Such hematological profiles can present simply as nonspecific lymphadenopathy. Here, we present a case of a 16-year-old boy with a complex presentation involving widespread lymphadenopathy, initially misdiagnosed as tuberculosis, ultimately revealing a dual hemoglobinopathy thus implying the need for family screening and consideration of late-onset hemoglobinopathies in cases with atypical presentations.

Intermittent intestinal intussusception in patients with mesenteric lymphadenitis in the ileocecal angle

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Top Five Causes of Neck Mass in Chattogram

Background: Identifying top problems in any discipline is very important for diagnosis and effective management. Unfortunately there is a knowledge gap in Chattogram, Bangladesh. To fill up the gap we have conducted the study.
 Materials and methods : It was a retrospective study based on hospital records of Chattogram General Hospital from January 2017 to December 2017. All (104) cases with neck mass were included. Age, sex, clinical diagnosis, histo-pathological diagnosis and management were noted. Data were managed manually.
 Results: Total 104 cases were studied among the cases 65% were female and 35% were male. 91% cases were of 10-50 years age group. Highest cases 33% were found in 20-30 years age group. According to Histo-pathological report 25% cases were Tubercular lymphadenopathy, Nonspecific lymphadenopathy were 17% and Multi-nodular goiter were 15%. Results were contrasted with previous studies.
 Conclusion: Top 05 causes of neck mass in Chattogram have been unveiled. Tuberculosis is still number one problem. So, TB control program should be evaluated further to find out causes of high TB cases in this region.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 18-20

The potential role of follicular helper T cells in idiopathic multicentric Castleman disease with and without TAFRO syndrome

Idiopathic multicentric Castleman disease (iMCD) is a systemic inflammatory disease of unknown etiology caused by hypercytokinemia. Recently, TAFRO (thrombocytopenia, anasarca, fever, renal failure or reticulin fibrosis, and organomegaly) syndrome has been reported, which shows similar histopathological findings to iMCD and factors associated with a poor prognosis. iMCD shows no plasma cell infiltration in the germinal center (GC), but CD38-positive (CD38+)-plasma cells are observed in the interfollicular area. Our previous report revealed that atrophic change of GC, glomeruloid vascular proliferation, and abnormal proliferation of follicular dendritic cells are more prominent in iMCD with TAFRO (TAFRO+) in comparison to iMCD without TAFRO (TAFRO−). In addition, the numbers of CD38+ and immunoglobulin G4-positive (IgG4+) plasma cells were decreased in the interfollicular area. The roles of T follicular helper cells (Tfh) are well-known to assist B-cell proliferation, maturation, and differentiation．It maintains the formation of GC and is also related in the class switching of IgG isotypes, including IgG4. Thus, we immunohistochemically examined the number of Tfh in GCs in both TAFRO− and TAFRO+ iMCD. The number of Tfh was significantly decreased in TAFRO− iMCD (n = 9) and was further decreased in TAFRO+ iMCD (n = 18) in comparison to non-specific lymphadenopathy (n = 6) and IgG4-related disease (n = 4). These results suggest that decreased Tfh may be one etiology of iMCD.

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.

Non-Specific Mesenteric Lymphadenitis and Cervical Lymphadenopathy in Pediatric Age Group – A Correlative Study

Background: The aim of the study is to assess the correlation between non-specific mesenteric lymphadenitis in children with cervical lymphadenopathy. Subjects and Methods: Total of 172 cases with Ultrasound features of non-specific mesenteric lymphadenitis reported in Department of Radiology, JSS medical college hospital, Mysore during the period of October 2016 & July 2018 were included in the study and correlated with Ultrasound of the neck. The clinical profile and attributed causes of these cases were correlated and evaluated. Results: Out of 172 cases, 60.5% of cases presented with pain abdomen being the most common symptom. Upper respiratory symptoms were noted in 37.2% of cases, diarrhea in 6.4% cases, urinary tract symptoms in 3.5% and fever in 18.6% of cases. Cervical adenopathy was noted in 72 cases (41.9%) of total cases out of which 55 cases had signs of upper respiratory tract infection. Conclusion: Ultrasound diagnosis of non specific mesenteric lymphadenitis is important to differentiate it from other causes of pain abdomen. Upper respiratory tract infection is one of the most common causes of non specific mesenteric adenitis and is associated with cervical adenopathy.

Clinicopathological study of cervical lymphadenopathy at rural tertiary health care centre

Background: The term lymphadenopathy refers to nodes that are abnormal in size, consistency or number. Cervical lymphadenothy is one of the common and important presentations of the underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and non-specific) and in immune deficiency disorders and also, the rare disorders like Inflammatory pseudotumour (Plasma cell granuloma) and Kikuchi-Fujimoto diseases. Etiological profile of cervical Lymphadenopathy varies from region to region, in developing countries like India, acute respiratory infection, suppurative skin infection and tuberculosis are the main causes for cervical lymphadenopathy while in developed countries secondary carcinoma are the most frequent causes for cervical lymphadenopathy.Methods: This hospital based cross sectional study was carried out in the Department of Otorhinolaryngology in Rural Tertiary Health Care Centre. The period of the study was from January 2014 to June 2016.Results: In our study of 176 patients the youngest patient was 13year of age and oldest patient was 68 years old. The majority of patients affected were in the age group of 21 to 30 years (30.68%) followed by 13 to 20 years (23.86%). The least affected age group was 60 to 70 years (5.8%). There were 80 men and 96 women. The male to female ratio in present study was 1:1.2 The frequently affected age group was 21 to 30 years in men (26.25%) as well as women (34.38%). In our study Neck swelling was present in all cases (100%). fever was the second most common symptom in 54 cases (30.68%) followed by cough in 45 cases (25.56%). In our study most frequently involved lymph node group was posterior cervical in 68 cases (38.39%), followed by upper deep cervical in 66 cases (37.50%).Conclusions: In the present study it was found that tuberculosis was the most frequent cause of cervical Lymphadenopathy in 48.29% of patients, followed by reactive Lymphadenopathy in 17.34%, metastatic lymphadenopathy in 15.34% chronic nonspecific Lymphadenopathy in 14.77% and primary lymphoreticular malignancy in 4.35%. In our study out of 176 cases of cervical lymphadenopathy 141 cases (80.11%) were non neoplastic and 35 cases (19.88 %) were neoplastic.

Patterns of lymph node pathology using biopsy evaluation tool for lymphadenopathy: a retrospective descriptive study conducted at Al Hussein Medical City 2014–2016

Objective The study was assumed to determine the histopathological spectrum of lymphadenopathic specimens where was a common site and showed the age and gender variation of these lesion distribution.Methods It was a descriptive retrospective study wherein 130 cases of lymph node biopsy reports of specimens from patients 3 months to 81 years at Al Hussein Medical City between 1 January 2014 and 31 December 2016 were studied.Results A total of 130 lymph node biopsies were received of which female 58.46% (76 cases) and male 41.53% (54 cases), a male to female ratio of 1:1.4 and the P value 0.011 with significance difference. The age range was from 3 months to 81 years. Most cases were seen in the age group of 21–30 years (25 cases 19.23%). The non-neoplastic lesions were more common comprising 66.9% (87 cases) included 46.9% (61 cases) of chronic nonspecific lymphadenitis, tuberculosis lymphadenitis 18.46% (24 cases) and other lesions 1.5%, while the neoplastic lesions 33.07% (43 cases) included non-Hodgkin lymphoma 13.07% (17 cases), Hodgkin lymphoma 12.30% (16 cases) and secondary metastasis 7.69% (10 cases). The more common site was cervical 93.07% (121 cases), axillary 4.6% (6 cases), inguanal 1.5% (2 cases) and mesenteric 0.7% (1 case).Conclusions The most common pathological pattern seen was chronic nonspecific lymphadenopathy (46.6%) followed by tuberculosis lymphadenitis 18.46%, non-Hodgkin lymphoma 13.07%, Hodgkin lymphoma 12.30%, and secondary metastasis 7.69% and others 1.5%. It is more common in female than male, and the more common site is cervical lymphadenopathy 93.07%. The earlier diagnosis and management of tuberculosis and earlier diagnosis of malignancies before the onset of nodal metastases may explain the result.

A prospective clinico-pathological study of cervical lymphadenopathy

Background: Lymphadenopathy refers to one or more lymph nodes that are abnormal in size, consistency or number. There are various causes for lymphadenopathy which range from benign conditions to malignant either primary or secondary from draining primary tumour. Lymphadenopathy can be localised to a single group or generalised.Methods: Prospective observational study was performed for the patients attending outpatient department of general surgery at Kamineni academy of medical sciences, LB nagar Hyderabad, Telangana with complaints of enlarged or swollen lymph nodes in the neck. This study included 46 cases. In cases where fine needle aspiration cytology was inconclusive and there was need for excision biopsy, only these cases were included in the study. After biopsy lymph node was sent for gross and microscopic examination for expert opinion from department of pathology.Results: The present study includes 46 patients in a period of two years from 01-8-2015 to 31-7-2017. Of these case tuberculosis lymphadenopathy (n=25,54.3%) was the most common aetiology followed by nonspecific chronic lymphadenopathy (n=16,34.7%) followed by some relatively rare cases and unusual presentation Schwannoma, pleomorphic adenoma, Kikuchi disease, non-Hodgkin’s lymphoma and secondaries from carcinoma tongue (n=1,2.1%).Conclusions: In the present prospective study tubercular lymphadenopathy was the most common cause for cervical lymphadenopathy followed by chronic nonspecific lymphadenopathy.

Evaluation of oral manifestations and oral health status among pediatric human immunodeficiency virus patients-under anti-retroviral therapy: A cross-sectional study

Introduction: The human immunodeficiency virus (HIV) acquired immunodeficiency syndrome disease has evolved to become a social and economic catastrophe, with far-reaching implications affecting every phase of life of the diseased individual. Data on adults and children diagnosed with HIV infection are useful for determining populations needing prevention and treatment services. Oral lesions may be the presenting symptoms of HIV infection and may differ entirely from those manifested in the adult population. Aim and Objective: We aimed to evaluate the prevalence of HIV related oral lesions among pediatric HIV patients and to assess the oral health status of HIV infected children residing in a selected childcare facility in Puducherry. Materials and Methods: A cross-sectional study was conducted during September 2015 in child care facility for HIV infected children located in Puducherry U.T, India. All children <18 years, who are diagnosed with HIV infection and are put on anti-retroviral therapy (ART) or pre-ART care, were included in the study. After obtaining informed consent from the care-givers and assent of the children, they were interviewed and examined by a team comprising a qualified dental surgeon and a trained physician. Results: Majority of the children were under first-line ART (73%) and were on ART for more than 4 years. The CD4 count of 23 (52.3) was between 500–1000 cells/μL. The recent viral load assay in 32 (72.7) patients was <150/not detected. Tooth decay was the most common oral manifestation with 28 (63.6) being affected. Nonspecific lymphadenopathy 26 (59.1) was the most common coexisting systemic illness. Conclusion: This study proves that constant surveillance by monitoring the general health status, CD4 counts, viral load coupled with stringent ART care has improved the overall quality of life of these children and consequently resulted in lesser oral manifestations.

Endobronchial ultrasound-guided transbronchial needle aspiration of hilar and mediastinal lymph nodes detected on18F-fluorodeoxyglucose positron emission tomography/computed tomography

ObjectiveEndobronchial ultrasound-guided transbronchial needle aspiration is of diagnostic value in hilar/mediastinal (N1/N2) lymph node staging. We assessed the utility of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer patients with N1/N2 lymph nodes detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography.MethodsFifty lung cancer patients with N1/N2 disease on 18F-fluorodeoxyglucose positron emission tomography/computed tomography underwent endobronchial ultrasound-guided transbronchial needle aspiration for pathological lymph nodes between November 2012 and April 2015. The diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration, lymph node site and size, number of needle passes and complications were evaluated retrospectively from patients' medical records. Malignancy was defined as a maximum standardized uptake value (SUVmax) >2.5.ResultsThe median longest diameter of the 61 lymph nodes (29 subcarinal, 21 right lower paratracheal, 6 left lower paratracheal, 4 right hilar and 1 upper paratracheal) was 23.4 mm (range: 10.4–45.7); the median number of needle passes was 2 (range: 1–5). There were no severe complications. A definitive diagnosis was made by endobronchial ultrasound-guided transbronchial needle aspiration in 39 patients (31 adenocarcinomas, 3 small-cell carcinomas, 2 squamous-cell carcinomas, 3 large-cell neuroendocrine carcinomas). In the remaining 11 patients, the diagnosis was indefinite: insufficient endobronchial ultrasound-guided transbronchial needle aspiration material was collected in two patients and non-specific lymphadenopathy was confirmed by endobronchial ultrasound-guided transbronchial needle aspiration or thoracotomy in the other nine patients. The mean lymph node SUVmax was 7.09 (range: 2.90–26.9) and was significantly higher in true-positive than in false-positive nodes (P < 0.05, t-test). Non-specific lymphadenopathy was diagnosed by expert visual interpretation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography images in five of the nine patients.ConclusionEndobronchial ultrasound-guided transbronchial needle aspiration accurately diagnoses N1/N2 disease detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

Serological and Molecular Investigations of Babesia Microti in Dogs from Southern Italy

Piroplasmosis is now considered emerging tick-borne zoonosis worldwide and domestic animals have been proposed as potential reservoirs for some piroplasm infections. The aim of this research was to identify the frequency of Babesia microti infection in untravelled dogs from Southern Italy (Sicily). Blood samples from 89 dogs were examined for the presence of Babesia microti antibodies and DNA. The dogs were infested with ticks. Among the examined dogs only one (1.16%) had B. microti antibodies, associated to B. canis, A. phagocytophilum and R. conorii infections. In the PCR assay, the dog was also found positive for B. microti and R. conorii DNA, and negative for other microorganisms. The infected dog showed a non-specific flu-like syndrome, with depression, disorexia, hyperthermia (39.6°C), light dehydration, moderate lymphadenopathy and heavy tick infestation (>20). No significant changes were present in the cell blood count. To the best of our knowledge, this is the first report of serological and molecular identification of B. microti piroplasm in a dog from Southern Italy. Because specific antibodies and DNA were detected in an untraveled dog, babesiosis is probably due to an autochthonous tick infection. However, this study indicates that Babesia microti is not widely distributed in dog populations in Sicily, as demonstrated by low prevalence of infection. So, in Sicily the dog would not appear to represent a reservoir of infection, but rather an accidental host.

A 13-Year-Old Girl with Recurrent Inguinal Lymphadenopathy

PEDIATRIC ANNALS 43:4 | APRIL 2014 Editor’s note: Each month, this department features a discussion of an unusual diagnosis in areas including genetics, radiology, or dermatology. A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at pedann@Healio.com. For diagnosis, see page 137 A13-year-old girl was referred to our hospital for diagnostic evaluation of recurrent inguinal lymphadenopathy. Eleven months before, she had been admitted to another institution with non-specific right inguinal lymphadenopathy associated with bi-monthly intermittent mild fever and hypochromic microcytic anemia, elevation of C-reactive protein (CRP), and hypergammaglobulinemia at blood screen. After excluding infectious causes by blood exams, diagnostic lymph nodal excisional biopsy was performed to exclude malignant etiologies. Histological examination showed nonspecific lymphoid hyperplasia, and the girl was discharged with the diagnosis of non-specific lymphadenopathy and irondeficiency anemia, with prescription of iron supplements. During the following months, follow-up blood exams showed persistence of anemia. At admission to our institution, the physical examination was unremarkable except for the presence of a mass in the inner upper aspect of the right thigh. An accurate history revealed that the mass had reappeared soon after the biopsy; the lesion was below the biopsy area and had enlarged slowly during the course of 10 months. It did not show any inflammatory signs (calor, dolor, rubor, or loss of function); had a solid, woody consistency; and was not movable. During the hospital stay, initial diagnostic workup confirmed persistence of microcytic anemia — interpreted as anemia of chronic disease — elevation of CRP and erythrocyte sedimentation rate (ESR) and hypergammaglobulinemia (Table 1). Considering the elevated inflammatory markers, antibiotic therapy was started. Nevertheless, all of the extensive microbiological tests performed both on blood and on bone marrow were negative. Indeed, an underlying infectious disease was excluded (Table 1). Auto-inflammatory causes and autoimmune diseases responsible for recurrent lymphadenopathy were also excluded because serum auto-antibodies screening results were negative (Table 1). An inguinal ultrasound scan revealed the presence of a 4 × 3 × 4 cm oval lesion in the internal upper side of the right thigh. The edges of the mass appeared to be well-defined, and it was predominantly Case Challenge

LYMPH NODE BIOPSIES IN A GENERAL INTERNAL MEDICINE DEPARTMENT: ALGORITHM OR INDIVIDUALIZED DECISION-MAKING?

Background: Lymphadenopathy (LA) imposes a diagnostic challenge in internal medicine. Exclusion of malignancy is the primary concern.Methods: A retrospective case series, including 40 adult patients from the general internal medicine department who underwent lymph node biopsy (LNB) at a single university hospital. Demographics, clinical data and histopathological diagnoses were registered. By means of the latest medical record, we obtained a final diagnosis for each patient and subsequently searched for variables correlated with malignancy. Follow-up was at least one year in 95% of cases.Results: The prevalence of malignancy was 58%. Older age (p = 0.02) was significantly correlated with malignancy. The presence of painful lymphadenopathy at clinical examination (p = 0.02) was significantly associated with a benign outcome. No single or combination of baseline variables satisfactorily excluded malignancy. Histopathological analysis correctly predicted malignancy in 93% of cases. In two cases, an initial diagnosis of benign non-specific lymphadenopathy was reversed to non-Hodgkin lymphoma. In one case the pathological diagnosis was inconclusive.Conclusion: Rather than following a universal algorithm to determine the need for LNB in patients with LA, we call for individualized decision-making in each case, carefully appreciating all available information. Additionally, one should keep in mind that false-negative results occur due to sampling errors. Therefore, a minimal number of cases should end with a final diagnosis of benign non-specific lymphadenopathy. Intensive, multidisciplinary cooperation with surgeon and pathologist is needed. Moreover, clinical follow-up should be at least one year.

“A Cystic Mass in the Head of the Pancreas” Case Report of Schwannoma

We report a case of a female (61 years) who presented with unspecific abdominal symptoms which motivated us a scan. This showed a cyst in the head of the pancreas. An abdominal CT scan confirmed the presence of a cystic tumor in the uncinated process of the pancreas measuring 27 mm in diameter, and nonspecific lymphadenopathy over the hepatic hilum. A MRI showed findings consistent with a Mucinous Cystic Neoplasia (MCN) at the pancreatic head. A pancreaticoduodenectomy was performed with excellent postoperative course, being the patient discharged from the hospital on POD 10. Pathological analysis showed a duodenal schwannoma of 31 × 24 mm (S-100 protein positive, CD 117 negative). No further treatment was indicated.

Orofacial and systemic manifestations in 212 paediatric HIV patients from Chennai, South India

Lesions in the mouth and in other tissues and organs (oral and systemic lesions) in paediatric HIV infection are diverse and show differences in clinical presentation and severity from that of adults. Very little data exist for oral lesions in paediatric population in India. To document and study oral and more widespread lesions in paediatric HIV seropositive patients. A cross-sectional study. Paediatric HIV seropositive patients at tertiary centers: Ragas Dental College and Hospital and YRG CARE, Chennai, India. Two hundred and twelve paediatric HIV patients aged 0-14 years seen over a period of 1 year were included in the study. Clinical history, oral and systemic examinations were recorded by qualified dental surgeons and physicians. One hundred and thirty-two patients had oral lesions ranging in number from one to three. Oral lesions included oral candidiasis (OC) (56.1%), gingivitis (10.8%), oral pigmentation (6.1%), depapillation of the tongue (5.7%), ulcers (4.2%), and oral hairy leukoplakia (1.4%). The most common systemic lesion observed was nonspecific lymphadenopathy (74.1%) followed by pruritic eruptions (53.8%), measles (51.4%), and tuberculosis (TB) (49.1%). Thirty-three (26%) patients were not immunosuppressed, 74 (58%) were moderately immunosuppressed, and 20 (15%) were severely immunosuppressed. Oral lesions exhibited positive correlation with lesions in other parts of the body. Oral lesions are a common feature in paediatric HIV infection. Their management is vital to improve the quality of life of the infected children.

Detection of recurrent extrahepatic hepatobiliary cystadenoma by EUS (with video)

We report on an unusual case of an extrahepatic hepatobiliary cystadenoma in a 52-year-old woman who initially was admitted to our hospital for laparoscopic cholecystectomy for cholecystolithiasis with cholestasis. During intraoperative cholangiography the course of the common bile duct (CBD) showed a broad notch of contrast agent that led to a longitudinal incision of the CBD after conventional laparotomy. A cystic mucinous lesion was found and simply enucleated from the CBD because there were no criteria for malignancy in the frozen section and the patient had not consented to an extended resection. Tumor marker (CA 19-9, cancinoembryonic antigen [CEA]) values were in the normal range. Final histologic examination showed a hepatobiliary cystadenoma of the CBD. Thirty months later, the patient reported colicky abdominal pain and jaundice in the emergency department. Abdominal US showed a distinct intrahepatic and extrahepatic cholestasis and a cystic lesion in the porta hepatis. During endoscopic retrograde cholangiopancreatography (ERCP), a sessile obstructive lesion in the mid portion of the CBD was found and a choledochal stent was inserted. After the patient recovered from jaundice, a CT scan was performed to clarify the diagnosis, but a final assessment was not possible because of CBD compression (Fig. 1). The subsequent EUS examination showed a cystic tumor adherent to the CBD wall with smaller surrounding daughter cysts without signs of infiltrative growth (Fig. 2, Video 1, available online at www.giejournal.org). Furthermore, nonspecific lymphadenopathy along the hepatoduodenal ligament was noticed. Tumor markers were again negative, and the patient was discharged after antibiotic treatment of cholangitis. Finally, she underwent choledochal resection and subsequent Roux-Y choledochojejunostomy 4 weeks later without any complications (Fig. 3). Histologic examination showed a recurrence of the mucinous cystadenoma with ovarian stroma (Fig. 4). The patient remains healthy after 4 months of follow-up. Figure 2EUS of cystadenoma within CBD with daughter cyst; CBD stent next to it with acoustic shadowing and an enlarged lymph node at the lower edge. View Large Image Figure Viewer Figure 3Intraoperative presentation of cystadenoma with ligation proximal and distal along the CBD. View Large Image Figure Viewer Figure 4Microscopic paraffin section of tumor with apical mucous producing cuboidal epithelium and typical ovarian-like stroma with fusiform cells (H&E, orig. mag. ×100). View Large Image Figure Viewer

Gastrointestinal involvement in Henoch-Schönlein syndrome: CT findings.

The purpose of this study was to describe the CT features of gastrointestinal involvement in seven patients with Henoch-Schönlein syndrome. Although the incidence of Henoch-Schönlein syndrome is low, it should be considered when CT scans show multifocal areas of bowel-wall thickening, mesenteric edema, vascular engorgement, and nonspecific lymphadenopathy. It should be considered especially in young patients with acute gastrointestinal symptoms.