A Giant Lymph Node—Liver Imposter

AbstractAbdominal tuberculosis has insidious course and is a diagnostic challenge. Tubercular lymphadenitis is associated with constitutional symptoms and multiple enlarged lymph nodes. Isolated giant lymph nodes are rare in tuberculosis and are common in lymphoma or malignancy. Peripancreatic mass on endosonography are commonly lymph node less than 4 cm. Isolated giant nonnecrotizing lymph node can mimic liver architecture on endoscopic ultrasound but lack a biliary connection.

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Reactive Lymphoid Hyperplasia or Tubercular Lymphadenitis: Can Real-Time PCR on Fine-Needle Aspirates Help Physicians in Concluding the Diagnosis?

Acta Cytologica ◽

10.1159/000488871 ◽

2018 ◽

Vol 62 (3) ◽

pp. 204-208 ◽

Cited By ~ 1

Author(s):

Vivek Gupta ◽

Arvind Bhake

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Real Time ◽

Predictive Value ◽

Lymphoid Hyperplasia ◽

Reactive Lymphoid Hyperplasia ◽

Rt Pcr ◽

Likelihood Ratios ◽

Diagnostic Challenge ◽

Cross Sectional

Background: Enlarged lymph nodes in adult patients often present a diagnostic challenge. In the absence of granuloma or necrosis, the cytology/tissue findings are misleading and relate the enlarged lymph nodes to reactive lymphoid hyperplasia (RLH), because granuloma formation is an immunological response that usually takes 14–100 days to develop. This study assesses the role of real-time (RT)-PCR in the diagnosis of the Mycobacterium complex (MTBC) in lymph node aspirates compared with culture in cases of RLH. Methods: A cross-sectional study was conducted on 112 patients, aged 15–74 years, with a diagnosis of RLH on cytology. RT-PCR for MTBC detection and culture on Löwenstein-Jensen medium for tubercular bacilli was done on lymph node aspirates. Comparative values with reference to culture were calculated. The χ2 value, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated. Results: Out of 112 RLH cases, 35 (31%) were positive on both RT-PCR and culture. RT-PCR was positive in 43 cases and culture was positive in 44 cases. The χ2 test was found to be highly significant. PPV, NPV, positive LR, and negative LR were 81.4%, 87%, 6.76, and 0.23, respectively. Conclusion: RT-PCR for MTBC proves to be useful in arriving at a conclusive diagnosis in patients with a cytological diagnosis of RLH.

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A case series of Kimura’s disease: a diagnostic challenge

Therapeutic Advances in Hematology ◽

10.1177/2040620718780370 ◽

2018 ◽

Vol 9 (7) ◽

pp. 207-211 ◽

Cited By ~ 5

Author(s):

Vivek Kumar ◽

Navneet Mittal ◽

Yiwu Huang ◽

Jasminka Balderracchi ◽

Huo Xiang Zheng ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Hodgkin's Disease ◽

Immunoglobulin E ◽

Hodgkin’S Disease ◽

Case Series ◽

Kimura’S Disease ◽

Pathological Features ◽

Diagnostic Challenge ◽

First Case

Kimura’s disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20–30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin’s disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin’s disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed–Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.

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Endoscopic ultrasound in the diagnosis of mediastinal diseases

Open Medicine ◽

10.1515/med-2015-0095 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Zhiguo Wang ◽

Chunmeng Jiang

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Endoscopic Ultrasound ◽

Mediastinal Lymph Node ◽

Lymph Node Status ◽

Mediastinal Lymph Nodes ◽

Mediastinal Diseases ◽

Mediastinal Lymphoma ◽

Tissue Acquisition

AbstractEUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.

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Incidental Anaplastic Lymphoma in a Case of Herpetic Hepatitis

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.223 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S102-S102

Author(s):

K Perrizo ◽

H laharwani ◽

S Jain ◽

J Lam

Keyword(s):

Lymph Node ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

Lymph Nodes ◽

Ct Scan ◽

Urine Analysis ◽

Diagnostic Challenge ◽

Presenting Symptoms ◽

Anaplastic Lymphoma ◽

Simplex Virus

Abstract Introduction/Objective The role of Herpes Simplex Virus (HSV) virus in the development of lymphomas is unclear and poses a diagnostic challenge along with limited literature explaining the relationship between HSV and Anaplastic large-cell lymphoma (ALCL). Methods A 26-year-old female admitted for intractable fever (103.7 F), chills, and dysuria; her urine analysis was suggestive of a mild urinary tract infection. During the admission, she developed abdominal pain with subsequent CT- scan showing thickening of the gallbladder and possible cholecystic fluid. Her liver function tests were: albumin 2.8 g/dL, AST 394 U/L, ALT 303 U/L, ALP 156 U/L, total bilirubin 0.3 INR 1. A subsequent Magnetic Resonance Cholangiopancreatography (MRCP) showed heterogeneous enhancement pattern of the liver without any masses following which she underwent cholecystectomy, during which her liver was abnormal along with an enlarged peri- cholic lymph node. Intraoperative biopsy of the liver showed patchy hepatocyte necrosis and occasional hepatocytes with ground-glass nuclei. The morphologic features were suggestive for Herpes Simplex Virus (HSV) hepatitis, and an HSV immunohistochemical stain confirmed this diagnosis. Removal of the lymph node showed a sinusoidal infiltrate of atypical lymphohistiocytic cells with abundant pale cytoplasm and large moderately irregular nuclei and occasional prominent amphophilic nucleoli. A few “hallmark”-like cells with curved nuclei were noted with rare mitosis. A panel of adequately controlled immunohistochemical stains showed positivity for CD4, CD30 (variable), and CD45. CD2, CD3, CD5, CD7, CD8, CD10, CD15, CD20, CD68 (positive in adjacent macrophages), BCL2, ALK1 were negative. Results Flow cytometry was negative for a neoplastic leukocyte population with a polytypic B-cell population. Taken together, a diagnosis of ALK1 negative, ALCL was made. A subsequent CT scan revealed borderline enlarged para- aortic lymph nodes along with an increased number of non-enlarged lymph nodes in the bilateral axillary, mediastinal, lower neck, and subpectoral regions. A bone marrow biopsy performed was negative for lymphoma. Conclusion Off note, her hepatitis serology panel, CMV, and HIV screens were negative. Thus, with her unusual presenting symptoms and no signs of malignancy led to numerous workups, which further led to an infectious cause, however, the patient was ultimately discovered to have an occult ALCL.

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Contrast-enhanced endoscopic ultrasound features of tubercular lymphadenopathy

Tropical Doctor ◽

10.1177/00494755211028057 ◽

2021 ◽

pp. 004947552110280

Author(s):

Surinder S Rana ◽

Nikhil Bush ◽

Saurabh Dawra ◽

Ravi Sharma ◽

Radhika Srinivasan ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Retrospective Analysis ◽

Endoscopic Ultrasound ◽

Great Majority ◽

Contrast Enhanced ◽

Heterogeneous Enhancement ◽

Ultrasound Features

There is lack of data on the contrast-enhanced endoscopic ultrasound features of tubercular lymph node; our retrospective analysis of 37 patients with enlarged mediastinal and abdominal lymph nodes showed heterogeneous enhancement in the great majority (70%).

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Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction

Respiration ◽

10.1159/000516505 ◽

2021 ◽

pp. 1-9

Author(s):

Roel L.J. Verhoeven ◽

Fausto Leoncini ◽

Jorik Slotman ◽

Chris de Korte ◽

Rocco Trisolini ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Endoscopic Ultrasound ◽

Area Under The Curve ◽

Objective Measure ◽

Future Research ◽

Malignancy Risk ◽

Nodal Size ◽

Risk Of Malignancy ◽

Roc Area

Background: Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. Objectives: We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. Methods: Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). Results: Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in <8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement. Conclusions: Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.

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Extramedullary Involvement of Lymph Nodes in Multiple Myeloma

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2016-0081 ◽

2017 ◽

Vol 18 (3) ◽

pp. 257-261

Author(s):

Zeljko Todorovic ◽

Milena Jovanovic ◽

Dusan Todorovic ◽

Anita Ivosevic ◽

Marina Markovic ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Lymph Node ◽

Lymph Nodes ◽

Plasma Cells ◽

Abdominal Ultrasound ◽

Diagnostic Challenge ◽

Rare Presentation ◽

Abdominal Lymph Node ◽

Bone Marrow Plasma

Abstract Myeloma multiplex is a malignant disease of bone marrow plasma cells. It is usually confined to the bone marrow, but in rare cases, patients can develop extramedullary disease. The involvement of lymph nodes is rare and can be a diagnostic challenge. Here, we describe a 36-year-old male patient who presented with abdominal pain and discomfort initially. An abdominal ultrasound followed by computed tomography (CT) revealed retroperitoneal and mesenteric lymph node enlargement. Biopsies of the abdominal lymph node and infiltrated colon showed a plasma cell infiltrate positive for CD79α, CD38, CD138, kappa light chain and VEGF2. Multiple myeloma with extramedullary localization was diagnosed. After six cycles of chemotherapy consisting of doxorubicin, dexamethasone and thalidomide followed by autologous haematopoietic cell transplantation, the patient achieved complete remission. Specifically, a CT scan after therapy showed enlarged lymph nodes in the abdomen, but PET CT scans did not detect any metabolically active foci. Thee years after the completion of therapy, the patient remains in remission. This case illustrates a rare presentation of extramedullary myeloma involving the abdominal lymph nodes, which could have been potentially mistaken for a lymphoid malignancy.

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Scanning electron microscopy of freeze-fractured prescapular lymph node of caprine

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111331 ◽

1984 ◽

Vol 42 ◽

pp. 244-245

Author(s):

O. Faroon ◽

F. Al-Bagdadi ◽

T. G. Snider ◽

C. Titkemeyer

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymphatic System ◽

Three Dimensional ◽

Meat Products ◽

The Body ◽

Morphological Data ◽

The World ◽

Cellular Constituent ◽

Scanning Electron

The lymphatic system is very important in the immunological activities of the body. Clinicians confirm the diagnosis of infectious diseases by palpating the involved cutaneous lymph node for changes in size, heat, and consistency. Clinical pathologists diagnose systemic diseases through biopsies of superficial lymph nodes. In many parts of the world the goat is considered as an important source of milk and meat products.The lymphatic system has been studied extensively. These studies lack precise information on the natural morphology of the lymph nodes and their vascular and cellular constituent. This is due to using improper technique for such studies. A few studies used the SEM, conducted by cutting the lymph node with a blade. The morphological data collected by this method are artificial and do not reflect the normal three dimensional surface of the examined area of the lymph node. SEM has been used to study the lymph vessels and lymph nodes of different animals. No information on the cutaneous lymph nodes of the goat has ever been collected using the scanning electron microscope.

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Body Distribution of Lipiodol 131J Following Intralymphatic Radiotherapy

Nuklearmedizin ◽

10.1055/s-0037-1621271 ◽

1965 ◽

Vol 05 (01) ◽

pp. 1-11

Author(s):

G. Fava ◽

L. Roncoroni

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

General Introduction ◽

Autopsy Findings ◽

Body Distribution ◽

Exact Data ◽

Radioisotope Therapy

SummaryAn account is given of the principles of lymph node dosimetry in radioisotope therapy with Lipiodol 131J. After a general introduction, exact data on the concentrations reached by the radionuclide in the lymph nodes, liver, spleen, thyroid and blood of patients subjected to this treatment are reported. Finally mention is made of a number of particularly interesting autopsy findings.

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Sentinel lymph node diagnostic in prostate carcinoma: Part II: Biokinetics and dosimetry of 99mTc-Nanocolloid after intraprostatic injection

Nuklearmedizin ◽

10.1055/s-0038-1625599 ◽

2002 ◽

Vol 41 (02) ◽

pp. 102-107 ◽

Cited By ~ 11

Author(s):

J. Kopp ◽

H. Vogt ◽

F. Wawroschek ◽

S. Gröber ◽

R. Dorn ◽

...

Keyword(s):

Bone Marrow ◽

Lymph Node ◽

Urinary Bladder ◽

Lymph Nodes ◽

Effective Dose ◽

Residual Activity ◽

Tracer Uptake ◽

Lymphatic Transport ◽

Radionuclide Distribution ◽

Radioactivity Uptake

Summary Aim: To visualise the sentinel lymph nodes (SLNs) of the prostate we injected the radiotracer into the parenchyma of the prostate. The activity was deposited in liver, spleen, bone marrow, urinary bladder and regional lymphatic system. The aim of this work is to determine biokinetical data and to estimate radiation doses to the patient. Methods: The patients with prostate cancer received a sonographically controlled, transrectal administration of 99mTc-Nanocoll®, injected directly into both prostate lobes. In 10 randomly selected patients radionuclide distribution and its time course was determined via regions of interest (ROIs) over prostate, urinary bladder, liver, spleen and the lymph nodes. The uptake in the SLNs was estimated from gamma probe measurements at the surgically removed nodes. To compare tumour positive with tumour free lymph nodes according to SLN-uptake and SLNlocalisation we evaluated 108 lymph nodes out of 24 patients with tumour positive SLN. For calculating the effective dose according to ICRP 60 of the patients we used the MIRD-method and the Mirdose 3.1 software. Results: The average uptake of separate organs was: bladder content 24%, liver 25.5%, spleen 2%, sum of SLN 0.5%. An average of 9% of the applied activity remained in the prostate. The residual activity was mainly accumulated in bone marrow and blood. Occasionally a weak activity enrichment in intestinal tract and kidneys could be recognized. The effective dose to the patient was estimated to 7.6 μSv/MBq. The radioactivity uptake of the SLN varied in several orders of magnitude between 0.006% and 0.6%. The probability of SLN-metastasis was found to be independent from tracer uptake in the lymph node. The radioactivity uptake of the SLNs in distinct lymph node regions showed no significant differences. Conclusion: The radiotracer is transferred out of the prostate via blood flow, by direct transfer via the urethra into the bladder and by lymphatic transport. Injecting a total activity of 200 MBq leads to a mean effective dose of 1.5 mSv. It is not recommended to use the tracer uptake in lymph nodes as the only criterion to characterize SLNs.

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