Diagnosis of Whipple's disease by peripheral lymph node biopsy

A peripheral lymph node (PLN) 1 cm or greater was found in 79 of 546 sarcoidosis patients (14.5%) between 1972 and 2005. Seventy-two of the 79 sarcoidosis patients had a lymph node biopsy performed. Sixty-seven of these biopsy specimens were histologically diagnosed as sarcoidosis, whereas five patients had a reactive adenopathy. For patients with histological diagnosis of sarcoidosis, localizations of the biopsies were as follows: cervical (n=21), supra-clavicular (n=20), inguinal (n=11), axillary (n=8), epitrochlear (n=5) and submandibular (n=2). At the time of biopsy, 12 patients had stage 0 disease, 37 patients had stage I disease, 14 patients had stage II disease and four patients had stage III disease. Skin involvement (16.4%) was the most frequently observed type of organ involvement in patients who had enlarged PLNs due to sarcoidosis. In the presence of an enlarged PLN in sarcoidosis, biopsy had a greater diagnostic value compared with other methods, as well as having a relatively low cost (approximately US$120) in Turkey. No procedure-related complications were observed. In conclusion, it is recommended that PLNs be thoroughly examined when sarcoidosis is suspected. If an enlarged PLN is found, biopsy should be routinely performed because it is an easy, convenient and practical method, with a low complication risk and a high sensitivity.

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P031 Whipple's disease: a multidisciplinary conundrum

Rheumatology ◽

10.1093/rheumatology/keab247.028 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Friederike Baldeweg ◽

Anna Nuttall ◽

Dhilanthy Arul ◽

Anna Childerhouse

Keyword(s):

Weight Loss ◽

Lymph Node ◽

Inflammatory Markers ◽

Lymph Node Biopsy ◽

Whipple’S Disease ◽

X Rays ◽

Whipple's Disease ◽

Palindromic Rheumatism ◽

Node Biopsy ◽

Pet Ct

Abstract Background/Aims A 45-year-old male patient presented in 2015 with a six-month history of relapsing and remitting polyarthralgia. Hand X-rays appeared normal. Serology showed mildly elevated inflammatory markers. Autoimmune profile including anti-CCP antibody, rheumatoid factor and ANA was negative. His initial diagnosis was palindromic rheumatism. He was under watchful waiting in rheumatology clinic having declined a trial of hydroxychloroquine, when in 2018 he developed severe epigastric pain. Over the subsequent 18 months he was noted to have dramatic weight loss, fatigue and drenching night sweats. Methods Investigations showed microcytic anaemia with elevated inflammatory markers (Hb 98 g/L, CRP 161 mg/L, ESR 68 mm/hr). Serum ACE, bone profile, thyroid function and urate levels were normal. Chest X-ray was unremarkable. HIV and hepatitis screening was negative. Endoscopy with jejunal biopsy was performed, with mild gastritis only on histopathology and normal D2 biopsies. He was found to be H pylori positive, and notably felt his B-symptoms much improved with triple antibiotic and PPI eradication therapy. CT abdomen demonstrated widespread mesenteric lymphadenopathy. Para-aortic lymph node biopsy showed non-necrotising granulomata suggestive of either sarcoidosis or an infective etiology such as tuberculosis (TB). Given the clinical picture, the patient was commenced on high dose oral prednisolone and methotrexate for suspected sarcoidosis. Results The patient made some clinical improvement, particularly with regards to arthralgia, however his B-symptoms returned with any reduction in steroid dose. Serology showed worsening anaemia with iron and folate deficiency, and increasing inflammatory markers. We therefore decided to perform a PET CT and refer to Haematology for consideration of a lymphoproliferative disease. PET CT demonstrated lymphadenopathy without avid uptake. A second lymph node biopsy was performed which showed florid histiocytic infiltration within which there were numerous PAS positive particles consistent with Whipple's disease. This was confirmed as tropheryma whipplei on PCR. Whipple's disease is a rare systemic infectious disease causing arthralgia, diarrhoea, abdominal pain and weight loss. Treatment consists of antibiotic therapy. On further questioning, the patient had grown up on a farm. There is a known association with Whipple's disease in the agricultural community as it is a soil-borne organism. Conclusion Our patient has made an excellent recovery. He remains under the care of our rheumatology team and the London School of Tropical Medicine and Hygiene. Treatment plan is 12 months of combined therapy with doxycycline and hydroxychloroquine. He underwent a lumbar puncture to rule out meningeal Whipple disease. We have also commenced sulfasalazine for persistent arthritis, which we feel could be a reactive phenomenon. Our key learning points from this case were to use a stepwise approach to diagnosis, involve relevant specialty teams and that it in complex cases it is useful to go back to the history. Disclosure F. Baldeweg: None. A. Nuttall: None. D. Arul: None. A. Childerhouse: None.

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Eosinophilic vasculitis: A Rare Presentation of Whipple’s Disease

Canadian Journal of Gastroenterology ◽

10.1155/2007/326174 ◽

2007 ◽

Vol 21 (3) ◽

pp. 189-191 ◽

Cited By ~ 10

Author(s):

Waleed Al-hamoudi ◽

Fadi Habbab ◽

Carmine Nudo ◽

Ayoub Nahal ◽

Kenneth Flegel

Keyword(s):

Lymph Node ◽

Lymph Node Involvement ◽

Lymph Node Biopsy ◽

Whipple’S Disease ◽

Whipple's Disease ◽

Rare Presentation ◽

Negative Results ◽

Mild Anemia ◽

Node Involvement ◽

Foamy Macrophages

Whipple’s disease is a multisystem infectious disease caused by the bacteriumTropheryma whippelii. A case with an unusual presentation is reported. A 66-year-old man presented with a febrile vasculitic rash on his forearms. An extensive rheumatological, hematological and infectious workup gave negative results, apart from mild anemia and eosinophilia. An abdominal computed tomography revealed a retroperitoneal lymphadenopathy, and a skin biopsy revealed an eosinophilic vasculitis. This diverted the work toward ruling out a lymphoma or a vasculitic process. A lymph node biopsy was then performed and showed a diffuse neutrophilic inflammation with abundant foamy macrophages, fat necrosis and lipogranuloma formation. These findings were considered to be nonspecific and no further pathological investigation was carried out. After a course of corticosteroids, diarrhea and weight loss predominated and subsequently a diagnosis of Whipple’s disease was confirmed on a small-bowel biopsy. Lymph node involvement was then confirmed on re-evaluation using the appropriate stains.

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Distinctive Peripheral Lymph Node Hyperplasia of Young Cats

Veterinary Pathology ◽

10.1177/030098588602300407 ◽

1986 ◽

Vol 23 (4) ◽

pp. 386-391 ◽

Cited By ~ 70

Author(s):

F. M. Moore ◽

W. E. Emerson ◽

S. M. Cotter ◽

R. A. DeLellis

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Plasma Cells ◽

Leukemia Virus ◽

Subsequent Development ◽

Lymph Node Biopsy ◽

Feline Leukemia Virus ◽

Peripheral Lymph Node ◽

Peripheral Lymph ◽

Lymph Node Hyperplasia

Peripheral lymph node enlargement was found in 14 of a series of 132 feline lymph node biopsy specimens. Six of nine cats tested had antibodies for feline leukemia virus (FeLV). Half of the cats were clinically normal while the remainder had fever, lethargy, anorexia, and hepatosplenomegaly. There was severe distortion of lymph nodal architecture with variable loss of discernible follicles and sinuses. Histiocytes, lymphocytes, immunoblasts, and plasma cells were present in expanded paracortical regions which encroached on, and occasionally effaced, lymphoid follicles. Postcapillary venules were numerous and prominent throughout the paracortex. The lymphadenopathy was most commonly transient (86% of cases) with subsequent development of lymphoma in one cat. Lymph nodes from seven kittens with experimental FeLV infection were compared with spontaneously enlarged lymph nodes; four of seven had B and T lymphocyte hyperplasia with normal nodal architecture. Three had partial loss of nodal architecture as a result of expanded paracortical regions populated largely by histiocytes and lymphocytes. Proliferation of postcapillary venules was not prominent in nodes from FeLV-infected cats. The cause of spontaneous lymph node hyperplasia of young cats was not determined. However, the similarity of lesions to those of kittens with experimental FeLV infection and the association with FeLV by serologic tests in six of nine cats suggest that this retrovirus may be involved in the pathogenesis of the lesion.

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Peripheral Lymph Node Excisional Biopsy: Yield, Relevance, and Outcomes in a Remote Surgical Setup

Surgery Research and Practice ◽

10.1155/2018/8120390 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ashish Lal Shrestha ◽

Pradita Shrestha

Keyword(s):

Lymph Node ◽

Diagnostic Yield ◽

Excisional Biopsy ◽

Needle Aspiration ◽

Lymph Node Biopsy ◽

Histopathological Diagnosis ◽

Peripheral Lymph Node ◽

Less Invasive ◽

Patient Profile ◽

Peripheral Lymph

Objective. To study the patient profile for symptomatic peripheral lymphadenopathy in terms of histopathological findings and demography and evaluate the yield, relevance, and outcomes of peripheral lymph node biopsy (PLNB) as a diagnostic step in a remote setup in the absence of less invasive options like fine-needle aspiration cytology (FNAC) or ultrasonogram- (USG-) guided FNAC. Methods. A retrospective review of patients undergoing PLNB between 1 May 2011 and 30 April 2013 was done. Demographics, histopathological reports, and outcomes were studied. Results. Of 132 patients, 51 (38.63%) were male and 81 (61.36%) were female. There were 48 (36.3%) patients in the age group less than 16 years, and 84 (63.6%) were beyond 16 years. The commonest site of biopsy was the neck in 114 (86.36%) patients. The histopathological diagnosis was tuberculosis (TB) in 60 (45.45%) patients, reactive lymphadenitis in 29 (21.9%), nonspecific granuloma in 18 (13.6%), lymphoma in 7 (5.3%), acute lymphadenitis in 7 (5.3%), metastatic secondary in 3 (2.2%), and other benign causes in 8 (6.06%). Conclusions. PLNB is a procedure with good diagnostic yield in evaluation of peripheral lymphadenopathy. Its relevance is appreciable in a remote setup where less invasive options are unavailable. Its simplicity and lack of mortality/significant morbidity make it a valid option in rural surgical practice.

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Surgical peripheral lymph node biopsies in Makurdi, Nigeria.

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2019.024 ◽

2019 ◽

Vol 6 (3) ◽

pp. 75-78

Author(s):

Barnabas Eke ◽

Babarinde Ojo ◽

Rymond Vhriterhire ◽

Issac Akper ◽

Victor Ugwu ◽

...

Keyword(s):

Lymph Node ◽

Teaching Hospital ◽

Diagnostic Yield ◽

Lymph Node Biopsy ◽

University Teaching ◽

Axillary Lymph ◽

Peripheral Lymph Node ◽

Peripheral Lymph ◽

Lymph Node Enlargement ◽

Common Causes

This study aims at determining the diagnostic value of peripheral lymph node biopsy and common causes of lymph node enlargement from biopsies obtained from patients with lymph-node enlargement at different sites in a teaching hospital in north central Nigeria town of Makurdi, Benue State. This is a retrospective study of surgical peripheral lymph node biopsies received in the department of Anatomic Pathology, Benue State University Teaching Hospital, Makurdi, Nigeria from February, 2012 to September, 2019. Total number of lymph node biopsies during the period was 47 representing 1.0% of surgical pathology specimens submitted to the department; 25 cases were females and 22 were males. Metastatic nodal involvement (57%), lymphoma (23%) and tuberculosis lymphadenitis (11%) were the most common causes of lymph node enlargement. All the studied nodes were localized. The most common sites of lymphadenopathy were axillary (21%), cervical (16%) and Inguinal (6%). While axillary lymph node enlargements were mostly associated with tumor metastasis, cervical and inguinal node enlargements were mostly associated with tuberculosis and lymphoma, respectively. Surgical excision of nodal enlargement for histological examination represents a simple, good diagnostic yield with lack of significant morbidity or mortality.

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When Is Lymph Node Biopsy Indicated in Children with Enlarged Peripheral Nodes?

PEDIATRICS ◽

10.1542/peds.69.4.391 ◽

1982 ◽

Vol 69 (4) ◽

pp. 391-396

Author(s):

Philip J. Knight ◽

Arlynne F. Mulne ◽

Louis E. Vassy

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Disease Process ◽

Lymph Node Biopsy ◽

Specific Diagnosis ◽

Node Biopsy ◽

Peripheral Lymph ◽

Lymph Node Enlargement ◽

Diagnostic Biopsy ◽

Reactive Hyperplasia

To better define the indications for diagnostic biopsy, 239 children who underwent peripheral lymph node biopsy were reviewed. The duration of the lymphadenopathy by history, the consistency of the lymph nodes, and the presence of more than one site of palpable adenopathy were not specific in differentiating serious diseases involving lymph nodes from reactive hyperplasia. The differential diagnosis of specific causes for lymph node enlargement is approached based on the child's age, the location of the adenopathy, and the presence or absence of lymph node fixation and tenderness. Most children with supraclavicular adenopathy, children sick with fever of one week's duration or with weight loss for which a specific diagnosis is not readily made, and some children with fixation of the lymph node to the overlying skin should undergo early biopsy. Excluding the above findings, when a specific diagnosis is not apparent, serial measurements with a ruler over several weeks appears to be the most reasonable method, at the present time, of discriminating hyperplastic lymph nodes from nodes that are involved by a progressive disease process.

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