Preauricular Node Research Articles

Cat-scratch disease subtle vertebral bone marrow abnormalities demonstrated by MR imaging and radionuclide bone scan

Cat-scratch disease (CSD) is a benign, self-limited cause of lymphadenitis occurring mainly in children and young adults. Its etiology is a delicate, small gramnegative pleomorphic bacillus. Less common manifestations of CSD are seen in 5% of patients and include Parinaud's oculoglandular syndrome (with enlargement of the preauricular nodes), parotid gland enlargement, encephalitis, radiculopathy, pneumonitis, erythema nodosum, thrombocytopenia, and lytic bone lesions. We describe a patient in whom magnetic resonance imaging initially detected subtle vertebral bone marrow abnormalities that correlated with the site of abnormality on a subsequent radionuclide bone scan.

Ａｎｇｉｏｓａｒｃｏｍａの長期加療例

A 55-year-old female visited our department 13 years ago because of a tumor accompanied by an alopecic patch in the frontal region of the scalp. The tumor was resected, and skin grafting was performed. After 3 years, recurrence around the skin graft and metastasis to the right preauricular parotid lymph nodes were observed. Local infusion of IFN, resection and electron beam irradiation were performed. After 2 years, induration developed in the right area of the neck. After 1 year, induration was also observed in the right area of the face. She temporarily improved after systemic administration of IL-2 and cyclophosphamide (CPA), but subsequently showed infiltration extending from the right area of the face to the entire scalp and the left area of the face. Administration of IL-2, CPA, CYVADIC and CPT-11 and adoptive immunity therapy were performed. In 1991, adenocarcinoma in the descending colon was resected. She died of respiratory failure caused by lung metastasis of the adenocarcinoma. She had followed up on an outpatient basis until 2 months before death. She is a rare patient treated for 13 years despite the very poor prognosis of angiosarcoma.

Tuberculosis of the parotid salivary gland in a kudu <i>Tragelaphus strepsiceros</i>

Tuberculosis is a bacterial disease which has a worldwide distribution and affects most animal and bird species. In the eastern Cape this disease has been known to affect the kudu since the turn of the century. Pre-existing lesions on the ears become infected with mycobacteria which causes swelling of the parotid gland and lymph nodes draining the area. In this article a case of tuberculosis is described affecting the parotid salivary gland and surrounding pre-auricular lymph nodes. The importance of tracing these lesions is stressed in order to prevent infection of people consuming the meat.

Merkel Cell Carcinoma of the Eyelid and Periocular Tissues

Five patients had eyelid and periocular Merkel cell carcinoma. The tumor was located on the left lower eyelid in two patients, the left upper eyelid in one patient, the right upper eyelid in one patient, and was metastatic to the right outer canthus in one patient. The mean duration of symptoms was approximately four months. The diagnosis of Merkel cell carcinoma was not suspected clinically in any of the four primary eyelid cases, but was only established on histopathologic examination of biopsy specimens. Light microscopy disclosed carcinoma with small primitive cells in all five tumor biopsy specimens. Immunohistochemical studies showed neuron-specific enolase and keratin and transmission electron microscopy demonstrated neurosecretory granules typical for Merkel cell carcinoma. All five patients in this study were treated with wide surgical excision of the eyelid tumors with intraoperative frozen-section monitoring of the margins of resection. The left lower eyelid Merkel cell carcinoma spread to the preauricular lymph node in one patient. This patient subsequently died of metastatic Merkel cell carcinoma. One patient with metastatic right outer canthus Merkel cell carcinoma received radiotherapy (6,550 cGy). Eyelid Merkel cell carcinoma has the potential for recurrence and metastatic spread. We recommend lifetime follow-up for patients treated for eyelid Merkel cell carcinoma.

Conjonctivite de Parinaud et tularémie : une étiologie rare à ne pas méconnaître

Tularemia oculoglandular is not common. We present a case with purulent conjonctivitis (Parinaud conjonctivitis) and swollen pre-auricular lymph nodes. The transmission was made by contaminated fingers.

Silicone rubber temporomandibular joint (TMJ) meniscal replacements: postimplant histopathologic and material evaluation.

Medical grade silicone rubber has long been considered a suitable meniscal replacement, but there has been increasing concern about migration of this material into adjacent tissues. The objectives of this study were to determine the definitive composition of tissue-incorporated material which is presumed by light microscopy to be silicone and to identify long term histopathologic sequelae of meniscal replacements. Adult female patients underwent meniscectomy and replacement with silicone rubber (Silastic) implants. After 12 to 18 months, recurrence of symptoms in 8% of these cases led to implant removal with excision of peri-implant fibrous pseudocapsules. Excised tissues, including one preauricular lymph node and implants were submitted for light microscopy, SEM, and energy dispersive x-ray microanalysis (EDX) for the identification of elemental composition, critical surface tension measurement, and internal reflection infrared spectroscopy. EDX revealed prominent peaks for silicon in both pseudocapsular and nodal tissues. Morphologic findings surrounding the long-term implants included foreign body reaction, synovitis, dystrophic calcification, fibrocartilaginous metaplasia, hyalinization, and scarring. Particulate silicone debris induced a pathologic response in the tissues and migrated to nodes. These findings suggest that periodic evaluation be performed over the life of such implants to rule out breakdown under function. These findings should intensify the search for improvements or replacements for silicone rubber as an interpositional material in the temporomandibular joint.

Toxoplasmosis of the preauricular and cervical lymph nodes: Report of a case

Toxoplasmosis is a parasitic infection caused by the obligate parasite, Toxoplasma gondii, that is distributed throughout the world. Lymphadenopathy, primarily of the cervical type, is one of the most commonly encountered clinical findings of acquired toxoplasmosis. It has been estimated that 15% of unexplained adenopathy is due to toxoplasmosis. 1 However, only a few cases of toxoplasmosis have been reported in dental literature. Cervical lymph node enlargement is also one of the most common clinical findings in dental clinics. This report details a case of toxoplasmosis that was manifested by preauricular and cervical lymphadenitis. The importance of recognizing lymphadenopathy as a possible clinical sign of toxoplasmosis is discussed.

マイボーム腺に原発した転移性頚部リンパ腺癌の一例

Many malignant tumors of various origin metastasize to the cervical lymph nodes. We examined a patient with metastatic cervical lymph node cancer secondary to a Meibomian gland adenocarcinoma. The patient was a 43-year-old male treated with right orbital exenteration after a diagnosis of Meibomian gland adenocarcinoma. After 8 months, the patient noted swelling of the right preauricular lymph node and parotid area. Biopsy showed lymph node recurrence of the same Meibomian gland adenocarcinoma. Treatment included right radical neck dissection and subtotal parotidectomy. This case shows that diseases not only of the ear, nose and throat area but also of the eye area can be associated with metastatic cervical lymph node cancer.

Immunomodulating properties and tissue distribution of aromatic retinoids in the immunologically responsive albino rabbit eye.

The effects of retinoid Ro 10-9359 no normal albino rabbit eyes and antigen-induced intra-ocular inflammations were investigated. The distribution pattern of intravenously applied 3H--Ro 10-9359 correlated well with the sites of pharmacological action. Whereas immunologically naive rabbits showed a uveal uptake of 0.164 ng/g wet wt. tissue when 100 micrograms of Ro 10-9359 was administered intravenously, accumulation may amount up to 17.46 ng/g in secondary ocular immune responses. Ro 10-9359 accumulated markedly during secondary stimulation in the uvea, preauricular lymph nodes and the spleen. The chemotactic peptide NForm-Leu-Leu-Phe used to incite a hypopyon attracted Ro 10-9359 into the anterior chamber in vivo. This study indicates that the aromatic retinoid Ro 10-9359 is able to alter certain immune responses and may be involved in intercellular communication during secondary immune responses in the albino rabbit eye.

Hemifacial microsomia and variants: pedigree data.

Ear malformations occur per se or together with other congenital anomalies. Many syndromes with ear malformations have been described. We have studied propositi with hemifacial microsomia (HFM) or Goldenhar syndrome (GS), also called oculoauriculovertebral "dysplasia" (OAV). In addition to ear malformations some individuals may have a small and/or malformed mandible, epibulbar, or conjunctival lipodermoids and anomalies of the cervical spine. Other malformations may also be seen. At present, the cause of these disorders is unclear. Here we present pedigree data on 97 propositi, 44 of whom had a family history of the same or similar anomaly. First-degree relatives were most often affected (35/433, 8%). Of 176 sibs tabulated, 11 (6%) were considered affected. The pattern of occurrence in many families suggested multifactorial determination, although other interpretations are possible. The occurrence of differing anomalies within a family suggests that the disorders constitute a single entity. The most frequent anomaly was a mild ear malformation (preauricular node or tag). This suggests a broad phenotypic spectrum. These data are useful for purposes of genetic counseling.

Immune response evoked by antigen injection in the rabbit vitreous combined with immunopotentiation.

Intravitreal injection of rabbits with antigen evokes a cell-mediated and a humoral immune response as detected by lymphocyte stimulation, skin testing, and hemagglutination tests. The results of the lymphocyte stimulation test largely correlate with the clinical evaluation of the inflammation process. Rabbits which have been sensitized by Freund's complete adjuvant at the moment of intravitreal antigen injection demonstrate a biphasic cell-mediated immune activity to this antigen. Intradermal or intraocular antigenic challenges of the rabbits 5 weeks following the intravitreal injection evoke responses with the characteristics of an Arthus reaction. At that moment, antigen-sensitized lymphocytes are found in the draining preauricular lymph nodes but not in the contralateral lymph nodes, suggesting separate functioning of these lymph tissues.

Experimental specific memory reaction to cornea, lens, and retina antigens.

Lymphocytes from rabbits immunized against various ocular extracts were challenged in vitro by the immunizing extract, by other ocular extracts from the same species, and by analogous extracts from other species. Immunological memory reaction, demonstrated by the blast transformation phenomenon, was found toward organ-specific and species-specific antigens. The organ cross-reactivity was greatest when cornea and lens were tested. Immunization of rabbits against calf cornea with extract emulsified in Freund adjuvant injected into the hind foot-pads induced the appearance of specific memory cells in popliteal lymph nodes, spleen, and blood. Immunization by interlamellar xenografting has shown that memory lymphocytes are mainly localized in the preauricular lymph nodes and are nearly absent from spleen and popliteal lymph nodes. These findings indicate the important role of the local immunological mechanism of the eye.

Meibomian gland carcinoma presenting as a lacrimal gland tumor.

This report describes a patient with a meibomian gland carcinoma that presented clinically as a lacrimal gland tumor with only minimal involvement of the adjacent eyelids. There was metastatic involvement of a right preauricular lymph node. Initial biopsy examinations of both the lacrimal gland and the preauricular node revealed a poorly differentiated carcinoma, primary site undetermined. Orbital exenteration, however, revealed that the lesion was a multifocal sebaceous carcinoma involving both upper and lower eyelids. Although meibomian gland carcinoma is not usually included in the differential diagnosis of tumors of the lacrimal gland, it should be considered when the clinician is confronted with a solid tumor in the fossa of the lacrimal gland.

Cellular Response of the Rabbit Eye to Primary Intravitreal Injection of Neisseria meningitidis

New Zealand White rabbits were injected intravitreally with approximately 2,500 viable or heat-killed meningococci. The rabbits were killed at intervals from 30 min to 14 days after injection. None of the rabbits produced detectable antibodies. Local antibody production by uveal tract, spleen, or preauricular lymph node cells was not demonstrated. Viable organisms were recovered from the vitreous at periods from 30 min to 48 hr after injection. Failure to recover viable organisms could be correlated with the appearance of large numbers of polymorphonuclear neutrophiles (PMN) throughout the vitreous. Animals injected with viable meningococci demonstrated a progressive inflammatory reaction characterized by an early accumulation of PMN in the vitreous, limbus, and conjunctiva. The cellular infiltrate gradually became mononuclear. By the 14th day postinjection only a few residual inflammatory cells remained at the limbus. This extensive cellular response was lacking in recipients of heat-killed organisms. The defense of the rabbit against intraocular introduction of meningococci therefore seems to be predominantly a cellular mechanism.

Herpes Simplex Keratoconjunctivitis

A 29-year-old mechanical engineer was seen in the Yale-New Haven Emergency Room with painful eyes, malaise, chills and fever. Five days prior to admission, a small quantity of turpentine had splashed into his left eye while he was wear­ ing a contact lens. The patient irrigated his left eye with water but did not see a physician until four days later, when his local physician pre­ scribed Neo-Cortef for a red, tearing, itching and burning left eye. The left eye felt better for 24 hours, then became painful, swollen and red, and the right eye felt irritated. A fever de­ veloped, malaise progressed and the patient came to the hospital. The patient had no prior similar disease. Mul­ tiple previous episodes of fever blisters had oc­ curred. ' Positive physical findings were fever of 103°F, a tender left preauricular lymph node and gen­ eralized cervical adenopathy. Several 2 to S-mm vesicles and open crusted lesions on an erythematous base were present on the nose, forehead and both eyelids. A vesicle was noted at the left angle of the mouth. Eye findings included: vision, R.E., 20/70; L.E., 20/60-2. The eyelids were swollen, lid mar­ gins were ulcerated, and the conjunctivas were edematous and injected (fig. 1). There was a clear watery discharge bilaterally. Both corneas showed nonspecific punctate epithelial staining pe­ ripherally and centrally. The remainder of the eye examination was normal. The patient was treated with Chloromycetin eyedrops for 24 hours. The next day, the eye findings were unchanged but, because of increased general malaise, he was admitted to the hospital. At this time additional pustular lesions of different ages were noted on both thighs. With a presumptive diagnosis of herpes simplex kerato­ conjunctivitis in a patient with generalized herpes, the patient was started on idoxuridine to the left eye and iodoxuridine soaks to the skin lesions of the left eyelid. The right eye was treated with Chloromycetin only. Two days after

Radiotherapy of carcinomas of the skin overlying the cartilages of the nose and ear.

Carcinomas of the cutaneous covering of the cartilaginous portions of the nose and pinna justify special consideration as a separate group from the standpoint of treatment. These carcinomas grow on parts of the facial anatomy which decisively influence the physiognomy of the patient. The skin overlying the nose and pinna is for the most part of very limited elasticity and is intimately attached to the underlying cartilage. These circumstances, except in very early superficial lesions, defy the possibility of wide surgical excision without resulting deformity or need for cosmetic repair. When properly administered, roentgen therapy offers excellent opportunity for cure and, in addition, the best possible esthetic results. It needs to be employed skillfully, however, in order to avoid the dreaded complication of chondronecrosis; but necrosis of the cartilage may result also from neglect of the superficial reactions and their secondary infection. Carcinomas of the skin of the nose and external ear occur rather frequently: those of the nose make up approximately 25 per cent and those of the ear about 8 per cent of all carcinomas of the skin of the face. Basal-cell carcinomas predominate in the nose, especially in the ala nasi, whereas squamous-cell carcinomas comprise most of the neoplasms on the pinna, particularly in the helix and antihelix. Regardless of their histologic character, malignant tumors of the skin of the nose and ears may extend to the cartilage and may become infected, forming an excavating ulcer and a permanent defect. Squamous-cell carcinomas of the nose may metastasize to submaxillary lymph nodes and those of the pinna to the preauricular nodes and to the upper cervical region; squamous-cell carcinomas of the ear are among the most highly metastasizing of all squamous-cell tumors of the skin. When metastases occur, they appear, as a rule, within a period of two years after the primary lesion. Treatment A variety of procedures have been and continue to be applied in the treatment of carcinomas overlying the cartilages of the nose and ear. Among them is the application of caustic pastes and acids, which usually result in considerable scarring and painful chrondronecrosis. Cautery and electrocoagulation may have similar consequences unless done superficially or in limited areas. At best, the procedures may succeed in controlling the tumor but at the price of a lesser esthetic result. Surgery: Surgery is perhaps the most widely applied treatment for small tumors in the areas under consideration. A simple excision may be possible for small, superficial lesions; this is an expeditious treatment, which should be followed by adequate microscopic examination of the specimen to assure the surgeon of the adequacy of the removal. Larger lesions require a skin graft because of the impossibility of bringing the borders of the wound together.

South American blastomycosis, Lutz's disease; a contribution to knowledge of its pathogenesis.

FOUR YEARS ago I started a systematic search for Paracoccidioides brasiliensis Almeida, 1930, in the teeth and periodontal tissues of brasiliensis Almeida, 1930, in the teeth and periodontal tissues of patients with South American blastomycosis (Lutz's disease). This study was undertaken in an effort to try to explain how the parasite in this disease gets into the organism with localizations, apparently primarily lymphatic, which simulate the Hodgkin-Sternberg disease. I started from the supposition that in some cases, and especially those in which the disease apparently begins in the suprahyoid, preauricular and retroauricular lymph nodes, the penetration of the fungus could take place by way of the teeth and periodontal tissues. Two years ago1I succeeded in finding P. brasiliensis in a granuloma of a carious tooth in a woman in whom the disease had apparently begun in the submandibular lymph nodes and in a retroauricular lymph node. The

The Fundamental Pathology of Infectious Myxomatosis

Infectious myxomatosis of rabbits was first described by Sanarelli in 1898 (1). Despite the peculiar features of the disease and the interest which it merits, studies on infectious myxomatosis have resulted in but thirteen papers and in several discordant statements as to its fundamental pathologic manifestations. The term “myxomatosis” by common usage implies that the process is neoplastic. Yet Aragao (2) states that the myxomatous tumors are not truly neoplastic, but merely remarkable collections of edematous fluid due to the presence of an infectious agent. Rivers (3) believes that in certain respects the infectious myxomatosis of rabbits resembles the Rous sarcoma of fowls, whereas in others it is quite different. It may serve to bridge the gap between virus tumor and vesicular, destructive virus diseases. It occurred to the writer that the early stages of the disease still merited purely morphologic investigation. A number of rabbits were inoculated, intradermally at first and by scratch inoculation from rabbit to rabbit later on. To secure as many involved lymph nodes as possible, the infection was usually introduced at more than one point, i.e . the thoracic skin near the axilla, near the groin, and the ear, to make certain of spread to the preauricular and cervical nodes. The animals were usually killed by air embolus at stages between the development of orbital and conjunctival lesions and the intense dyspnea preceding death from the disease itself. All organs, the subcutaneous tissues and skin, and as many lymph nodes as possible, were preserved for study. Tissues were fixed in absolute alcohol for mucin, in 10 per cent formalin, and in Zenker's fluid. The stains employed were mucicarmine, hematoxylin and eosin, eosin-methylene blue, Wright's blood stain which was found to give excellent results on formalin-fixed tissues, Giemsa stain, and Mallory's phosphotungstic acid hematoxylin.