Patients Undergoing Node Biopsy Research Articles

Histiocytic necrotizing lymphadenitis with hemophagocytic lymphohistiocytosis in adults: A single-center analysis of 5 cases.

Histiocytic necrotizing lymphadenitis (HNL) is a self-limited inflammatory disease of unknown pathogenesis. A very small fraction of patients with HNL could develop hemophagocytic lymphohistiocytosis (HLH), a hyperinflammatory disorder. These patients are diagnosed as HNL with HLH (HNL-HLH). HNL-HLH in the pediatric population has been systemically studied, however, the clinical, laboratory, and radiological features and outcomes of adult patients with HNL-HLH remain to be explored. We aimed to explore the clinical, laboratory, and radiological features and outcomes of adult patients with HNL-HLH. We collected the clinical data of patients with HNL-HLH admitted to the First Affiliated Hospital of Nanjing Medical University from October 2010 to June 2015. All the patients underwent lymph node biopsy and have a pathological diagnosis of HNL. The age, gender, clinical presentation, lymph node signs, laboratory findings and imaging data, and pathological findings of the patients were collected. In this study, we reported five adult patients with HNL-HLH. All five patients showed enlarged lymph nodes and prolonged fever. Laboratory findings were consistent with the diagnosis of HLH. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed enlarged lymph nodes with increased FDG uptake and splenic hypermetabolism could be present. All the patients responded well to corticosteroids and had a good prognosis. Two of the five patients were diagnosed with systemic lupus erythematosus during the follow-up. Our study demonstrated that adult patients with HNL-HLH showed distinct clinical, laboratory, and radiological features. And the prognosis is good and patients could be managed with steroids and supportive care.

Histiocytic Necrotizing Lymphadenitis with Hemophagocytic Lymphohistiocytosis: A Single-Center Analysis of Five Cases

Introduction: Histiocytic necrotizing lymphadenitis (HNL) is a benign, self-limiting disease that presents with few nonspecific symptoms such as fever and swollen lymph nodes in the neck. Histiocytic necrotizing lymphadenitis with hemophagocytic lymphohistiocytosis (HNL-HLH) is rare and case series have been reported in children. HNL-HLH in adults has not been systematically analyzed. Methods: We aimed at exploring the clinical, laboratory, and radiological features and outcomes of adult patients with HNL-HLH. We collected the clinical data of patients with HNL-HLH admitted to the First Affiliated Hospital of Nanjing Medical University from October 2010 to June 2015. All the patients underwent lymph node biopsy and have a pathological diagnosis of HNL. The age, gender, clinical presentation, lymph node signs, laboratory findings and imaging data, and pathological findings of the patients were collected. Results: In this study, we reported five adult patients with HNL-HLH, including 3 females and 2 males. The median age was 37 years (range: 20-57). All five patients showed enlarged lymph nodes and prolonged fever. Laboratory findings were consistent with the diagnosis of HLH. All five patients had hyperferritinemia and the levels of ferritin were all higher than 1000 ug/L. Serum lactate dehydrogenase (LDH) and aminotransferase were significantly elevated in all five patients. 18F-FDG PET/CT showed enlarged lymph nodes with increased FDG uptake and splenic hypermetabolism could be present. Pathological findings were consistent with HNL (Fig A) and hemophagocytosis in the lymph node was present in two cases (Fig B). All the patients responded well to corticosteroids and had a good prognosis. Two of the five patients were diagnosed with systemic lupus erythematosus (SLE) during the follow-up. Conclusion: Our study demonstrated that adult patients with HNL-HLH showed distinct clinical, laboratory, and radiological features. And the prognosis is good and patients could be managed with steroids and supportive care.

Lymph node biopsy in children: Indications and etiology

Background: Peripheral lymphadenopathy manifests in a variety of benign and malignant conditions and is often challenging to distinguish pathologic from non-pathologic etiology based on clinical presentation alone. Therefore, lymph node biopsy is often required as an essential part of management. This study aimed to determine the causes of peripheral lymphadenopathy in children needing excision biopsy in our setting and establish a correlation with clinical features and laboratory findings. Methods: A retrospective review of medical records of children aged 0-14 years undergoing lymph node biopsy at our institution, between January 2015 and June 2018, was conducted. Demographic, microbio­logical, and histopathological findings were reviewed. Results: A total of 69 patients underwent lymph node biopsy, the majority of whom were male (n=40, 58%), with a mean age of 7.9 years. The histopathological findings confirmed lymphoma (n=27), tubercu­losis (n=24), benign reactive changes (n=14), and Langerhan Cell Histiocytosis (n=4). Cervical lymph nodes were most frequently involved (n=64). Associated symptoms included fever (n= 27), weight loss (n=2) and cough (n=7). Only one patient developed a postoperative complication (wound infection). A clini­cal diagnosis of tuberculosis (TB) had been presumed in 19 patients, but only 2 (11%) were confirmed to have TB, whereas10 were found to have histopathological findings of lymphoma. Conclusion: Excisional biopsy is useful in the management of children with lymphadenopathy, allowing treatment to be initiated based on a histopathological diagnosis.

Comparative analysis of biopsy proven lymph node positive bladder cancer patients to those with biopsy proven lymph node negative disease prior treatment.

475 Background: Many studies assessing the efficacy of chemotherapy before surgery include few clinically node positive patients or completely exclude them which make response rates in this particular subset of patients difficult to determine. Additionally, these patients are clinically node positive, making true nodal response rates unable to be determined. We report a descriptive analysis of patients with clinically node positive disease who underwent lymph node biopsy prior to any treatment and their outcomes. Methods: Data was obtained retrospectively from patients with cTanyN1-3M0 bladder cancer from 2006-2017 who underwent radical cystectomy at MD Anderson. SPSS was used for statistical analysis. Results: Among the 120 patients with cTanyN1-3M0 (median follow up 27.4 months), 40 patients underwent lymph node biopsy (LNBx). 26 (65%) patients had a positive LNBx, 14 (35%) were negative. 100% of the patients with a positive LNBx underwent primary chemotherapy. On final cystectomy, 9 (34.6%) of those patients had complete nodal response (pN0) and 9 (34.6%) had complete bladder response (pT0). 7 were pT0N0. Of the patients with a negative LNBx, 11 (78.6%) underwent neoadjuvant chemotherapy and of those patients, 7 (63.6%) were pN0 and 4 (36.4%) were pT0. Of patients that did not undergo LNBx that received primary chemotherapy (78 patients), 41 (52.6%) were pN0 and 22 (28.2%) were T0. There was no significant difference in overall or recurrence free survival between patients with a positive or negative biopsy or who did not undergo biopsy (p = .474). There was a significant improvement in overall and recurrence free survival in patients with negative nodal disease on final pathology compared to those with positive nodal disease (p < 0.001). Conclusions: Patients that had a negative LNBx were less likely to undergo primary chemotherapy. Pathologic bladder response rates correlate with nodal response rates. In cN+ patients, overall survival and recurrence free rates are not significantly different in patients without a lymph node biopsy, a positive biopsy or a negative biopsy. Finally, advanced final pathologic stage predicts worse outcomes.

Laparoscopy has a superior diagnostic yield than percutaneous image-guided biopsy for suspected intra-abdominal lymphoma.

To date, no study has compared laparoscopy (LB) to percutaneous (PB) biopsy for the diagnosis of abdominal lymphoma. The objective of this study is to compare the success rate and safety profile of laparoscopic lymph node biopsy to the percutaneous approach in patients with intra-abdominal lymphadenopathy concerning for lymphoma. We performed a multi-institution, retrospective review of patients undergoing lymph node biopsy for suspected intra-abdominal lymphoma between 2005 and 2013. Our primary outcome was adequate tissue yield between the two techniques, both for histologic diagnosis and for ancillary studies such as flow cytometry. Secondary outcomes included 30-day morbidity, 30-day readmission rates, the need for additional lymph node biopsy procedures, and length of stay. All 34 of the LB patients had adequate specimen for histologic diagnosis compared to 92.3% of patients with a PB (p = 0.18). Significantly more patients in the LB group had sufficient tissue for ancillary studies when needed than in the PB group, 95.5 and 68.2%, respectively (p = 0.04). A second biopsy was pursued in 23.1% of failed PB patients, 0% with success on second attempt. When index of suspicion is high or when biopsy is performed for patient previously diagnosed with lymphoma and recurrence/transformation is suspected, LB safely and consistently provides adequate tissue for initial diagnosis and for ancillary studies. In contrast, image-guided PB may be more appropriate for patients for whom ancillary studies are unlikely to add to planned treatments or when there is a high risk of complications from either general anesthesia or patient comorbidities.

Whole-Blood Interferon-Gamma Release Assay for Diagnosis of Tuberculous Lymphadenitis

Tuberculosis remains a major problem for much of the world. Tuberculous lymphadenitis is the most common type of extrapulmonary tuberculosis, although a difficult invasive procedure is required for its diagnosis. We evaluated the usefulness of the whole-blood interferon-gamma release assay (IGRA) for diagnosis of tuberculous lymphadenitis. From January 2008 to October 2010, 108 patients underwent lymph node biopsy and the IGRA concurrently in Wonju Christian Hospital, Yonsei University Wonju College of Medicine. Among the patients, 27 were diagnosed with tuberculous lymphadenitis and 81 were diagnosed with non-tuberculous lymphadenitis. The diagnostic performances of the IGRA were evaluated. The median patient age was 33 years (interquartile range [IQR] 23.5 to 48 years), and 28 (25.9%) patients were male. No patient was administered immunosuppressive agents such as high-dose steroids or underwent chemotherapy within 90 days before the IGRA test. The IGRA was positive in 25 of 27 patients with tuberculous lymphadenitis and in 13 of 81 patients with non-tuberculous lymphadenopathy. Therefore, the sensitivity of IGRA was 92.6% (95% CI, 82.0 to 100), and the specificity was 80.2% (95% CI, 71.4 to 89.1). In the patients with positive IGRA results, the INF-γ concentration was significantly higher in the patients with tuberculous lymphadenitis compared to that in the patients without tuberculous lymphadenitis (15.58 [IQR 6.87 to 45.10] IU/mL versus 0.97 [IQR 0.65 to 2.41] IU/mL, p < 0.001). In conclusion, the IGRA is helpful for the diagnosis of tuberculous lymphadenitis.

Importance of human immunodeficiency virus-associated lymphadenopathy and tuberculous lymphadenitis in patients undergoing lymph node biopsy in Zambia.

The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.

FDG-PET for staging of rhabdomyosarcoma

8545 Background: Complete staging of rhabdomyosarcoma is critical for delivery of appropriate therapy. Current diagnostic tools have known limitations. We have evaluated the role of 18F fluorodeoxyglucose positron emission tomography (PET) in the staging of patients with rhabdomyosarcoma. Methods: Since 1997, 60 patients with rhabdomyosarcoma underwent 159 PET scans. Of these, 21 patients with a median age of 11 years had a PET scan as part of their initial staging evaluation, before or within 13 days of initiation of therapy. Twelve patients had alveolar and 9 had embryonal histology. Primary sites included parameningeal (11), extremity (4), trunk (3), bladder/prostate (2), and head and neck (1). Results from CT, MRI, bone scan, and pathology within 1 month of the PET were compared. Results: A total of 83 sites were evaluated. All 21 patients had positive PET scans at the primary site. Twenty six PET positive sites at primary or nodal regions were biopsied and in all sites disease was confirmed. Standardized uptake value (SUV) for the primary site at the time of diagnosis ranged from 2.4 to 12.7 (mean 5.7). All SUVs prior to therapy were ≥4. There was no significant difference in SUV when evaluated by primary site or histology. PET showed involvement of regional lymph nodes in 12 patients. Five of the 12 patients underwent lymph node biopsy, all confirming involvement. In 3 of these cases, CT or MRI failed to detect the regional involvement identified on PET. At 11 sites, CT or MRI was equivocal for detection of regional or distant spread. In these cases, PET confirmed disease in one case and excluded disease in 10 cases. PET failed to capture sites of disease visualized by CT, MRI, or bone scan at 10 sites, including pelvic, paraaortic, mediastinal, cervical and retropharyngeal lymph nodes as well as vertebral bodies. When comparing PET to the final clinical determination of disease extent, PET was 83% sensitive and 97% specific. Conclusion: These preliminary data indicate that PET is a useful adjunct in the initial staging of rhabdomyosarcoma. In 3 of 21 cases (14%), therapy was altered because of nodal disease detected only on PET. A prospective study of PET for staging of rhabdomyosarcoma is warranted. No significant financial relationships to disclose.

The Increased Burden of Tuberculous Lymphadenitis in Central Africa: Lymph Node Biopsies in Lusaka, Zambia, 1981 and 1990

In order to assess the effect of the HIV epidemic on lymph node biopsies in Central Africa, HIV-1 serology was tested on a cohort of patients undergoing node biopsy in Lusaka in 1990, and the histology of all lymph nodes biopsied in Lusaka in 1981 and 1990 was reviewed. One hundred and eighteen lymph nodes were biopsied in 1981 and 351 in 1990. Cases of tuberculous lymphadenitis increased from 52 (31 children and 21 adults) in 1981 to 186 (22 children, 160 adults, four patients unknown age) in 1990. Sixty-eight of 77 adults (88%) with tuberculous lymphadenitis in 1990 tested HIV-positive. Cases of histology suspicious of primary HIV lymphadenopathy and nodal Kaposi's disease also increased. Cases of malignant lymphadenopathy and overall number of surgical biopsies remained equivalent for 1981 and 1990. The study concludes that the HIV epidemic has led to a large increase in diagnostic lymph node biopsies in Lusaka, mostly through an increase in HIV-related adult tuberculous lymphadenitis.

Role of Fine needle aspiration cytology in the diagnosis of Cervical lymphadenopathy

Objective: A study was carried out to know the overall prevalence of various causes responsible for cervical lymphadenopathy of more than 3 weeks duration. FNAC has been evaluated as a diagnostic tool in our clinical set up. We aimed to present 120 cases which we treated in our center within last 4 years. Methods: A retrospective study has been carried out from August 2007 to August 2011 in the department of Otolaryngology and Head-Neck Surgery at CMH Rangpur, Apollo Hospitals Dhaka And Ibn Sina Medical College Hospital Dhaka. All patients presented with cervical lymphadenopathy of more than 3 weeks duration. FNAC has been done for all suspected cases. CT neck has been done in 4 cases for deep jugular nodes. 60 patients underwent lymph node biopsy as FNAC report was non-specific lymphadenitis. For three cases we have done frozen section biopsy. Preoperative workup with routine blood tests, Xray chest and tuberculin tests have been carried out for all cases. Results: Out of 120 FNAC of cervical lymphadenopathy - 60 were non-specific lymphadenitis, 34 were tuberculosis, 13 were metastatic (with 2 occult primary), 7 were lymphomas (Immunocytochemistry proved ) and 6 were abscess. All 60 non-specific lymphadenopathy cases (FNAC report) underwent lymph node biopsy.5 cases were consistent with tuberculosis , 1 was lymphoma and rest were reactive . For 3 cases frozen section biopsy have been done. One was consistent with granulomatous disease and two cases were diagnosed as lymphoid hyperplasia. Both the lymphoid hyperplasia cases have been diagnosed as Castleman's disease after histopathology report. Conclusion: The study concluded the fact that the non-specific infection is the most common cause of cervical lymphadenopathy followed by tuberculosis .Supplemented with routine laboratory investigations, FNAC give very important clue to the physicians that can be routinely used in patients with cervical lymphadenopathy. DOI: http://dx.doi.org/10.3329/bjms.v11i1.9818 BJMS 2012; 11(1): 25-27