UTILITY OF ULTRASONOGRAPHY DIAGNOSIS FOR CERVICAL LYMPHADENOPATHY IN CENTRAL INDIAN POPULATION- A HOSPITAL BASED OBSERVATIONAL STUDY

Background: Cervical lymph nodes are frequently involved in a number of disease conditions. The most commonly seen causes of cervical lymphadenopathy are tuberculosis, distant metastasis and lymphoma. Objective: To assess the usefulness of ultrasonography in the differential diagnosis of cervical lymphadenopathy. Methods: ultrasonography of cervical lymph nodes was performed with a real-time linear scanner using a 7.5- or 11-MHz probe. Ultrasonography findings were retrospectively reviewed in 432 lymphnodes of 120 patients. USG findings were reevaluated by FNAC, CECT neck, MRI and core needle biopsy wherever required. Results: out of 432 lymphnodes; 108 tuberculous lymphadenitis, 46 metastatic, 59 lymphoma, 114 inflammatory and 105 normal lymph nodes were observed. Ultrasonography features were found to be stronger in tubercular, metastatic and lymphomatous lymphnodes. Hypoechoic center was prominently observed in tubercular and metastatic form. In most of the patients, FNAC result was equivocal and a subsequent excision biopsy of the lymph node was carried out to confirm the diagnosis. Lymphadenitis was diagnosed with a sensitivity of 100% and a specificity of 100%. Conclusion: This study concluded that cervical group of lymph nodes with ultrasonography features such as round shape, absence of hilar echo, sharp nodal borders, Hypoechoic internal echogenicity and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes. Ultrasonography along with other radiological and histopathological parameters can be very effective in early diagnosis of high risk diseases. Keywords: Ultrasonography; Tuberculous Lymphadenitis; Malignant Lymphoma; Metastatic Node

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Rare Presentation of Self-Limiting Kikuchi–Fujimoto Disease in Relapsing Nature

Case Reports in Medicine ◽

10.1155/2020/9785104 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Karo Servatyari ◽

Hero Yazdanpanah ◽

Chamara Dalugama

Keyword(s):

Lymph Nodes ◽

Wide Spectrum ◽

Clinical Manifestations ◽

Cervical Lymphadenopathy ◽

Excision Biopsy ◽

Presentation Of Self ◽

Rare Presentation ◽

Cervical Lymph Nodes ◽

One Year ◽

Loss Of Appetite

Background. Kikuchi–Fujimoto disease (KFD) is a rare, benign, and self-limiting disease that is commonly associated with cervical lymphadenopathy and fever. The disease has a wide spectrum of clinical manifestations, and definitive diagnosis is based on the histological appearance in the excision biopsy of the lymph nodes. Recurrence of KFD is reported rarely. Case Presentation. A 56-year-old Iranian woman with a background history of thrombocytopenia presented with fever, malaise, loss of appetite, and weight loss with cervical lymphadenopathy. The excision biopsy of the cervical lymph nodes confirmed the diagnosis of KFD, and she made a full recovery with improvement of symptoms, regression of cervical lymph nodes, and normalization inflammatory markers. One year after remission, she presented with similar clinico-biochemical profile, and repeat biopsy confirmed KFD. Conclusion. Although the rate of recurrence of the disease is very low, the treating physician should consider the possibility and confirm it histologically.

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Histomorphological Pattern of Cervical Lymphadenopathy

Journal of Enam Medical College ◽

10.3329/jemc.v3i1.13837 ◽

2013 ◽

Vol 3 (1) ◽

pp. 13-17 ◽

Cited By ~ 1

Author(s):

Md Atiqur Rahman ◽

Md Mamun Ali Biswas ◽

Syeda Tasfia Siddika ◽

Abdul Mannan Sikder

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Hodgkin Lymphoma ◽

Cervical Lymphadenopathy ◽

Histological Evaluation ◽

Cervical Lymph Nodes ◽

Female Ratio ◽

Study Results ◽

Metastatic Neoplasm ◽

Age And Sex

Background: Enlarged palpable cervical lymph nodes as a primary presenting sign are very common and may be due to inflammatory lesions and tumors. Correlation between clinical findings and laboratory data is essential in arriving at a diagnosis. In patients presenting with cervical lymphadenopathy, excision biopsy provides material to establish an early diagnosis. We designed this study in our population for histological evaluation of cervical lymph node biopsies that might be important in the management of these patients. Objective: Histopathological evaluation of different diseases involving the cervical lymph nodes in relation to age and sex of the study population. Materials and Methods: It was a cross sectional study conducted in the department of Pathology, Enam Medical College & Hospital, Savar, Dhaka during the period from January 2006 to December 2010. A total of 107 patients were evaluated for specific cause of cervical lymphadenopathy in relation to age and sex. Lymph node biopsies of all patients of both sexes and all age groups were included in the study. Results: Among the 107 subjects 58 (54.2%) were males and 49 (45.8%) were females with a male to female ratio of 1.2:1. The age of the patients ranged from 2 to 85 years with a mean age of 32.68 ± 18.01 years. Of the 107 lymph node biopsies, 34 cases (31.8%) were reactive lymphadenitis, 41 cases (38.3%) were tuberculosis, 2 cases (1.9%) were non-caseous granuloma, 6 cases (5.6%) were Hodgkin lymphoma, 8 cases (7.5%) were non-Hodgkin lymphoma, 12 cases (11.2%) were metastatic neoplasm and 4 cases (3.7%) were other specific lesions. Conclusion: The commonest cause of cervical lymphadenopathy was tuberculosis, followed by reactive lymphadenitis, lymphoma and metastatic neoplasm. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13837 J Enam Med Col 2013; 3(1): 13-17

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A prospective clinico-pathological study of cervical lymphadenopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20175393 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3967

Author(s):

Narender N. R. ◽

Yadagiri Rao J.

Keyword(s):

Lymph Nodes ◽

Prospective Observational Study ◽

Primary Tumour ◽

Cervical Lymphadenopathy ◽

Needle Aspiration ◽

Excision Biopsy ◽

Medical Sciences ◽

Aspiration Cytology ◽

Needle Aspiration Cytology ◽

Carcinoma Tongue

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.

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SAT-LB63 A Case of PTHrP-Negative Hypercalcemia of Malignancy

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2125 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jonila Murati ◽

Ariana Cannavo ◽

Sun Lee ◽

Elizabeth N Pearce

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Squamous Cell ◽

Elevated Serum ◽

Cervical Lymphadenopathy ◽

Neck Mass ◽

Common Finding ◽

Cervical Lymph Nodes ◽

Hypercalcemia Of Malignancy

Abstract Case Presentation: A 55-year-old male who had recently arrived from Haiti presented to the Emergency Department with chief complaint of a progressively enlarging neck mass. He first noticed the mass in 2000. From 2000-2017, he underwent resection of the mass three times in Haiti, with recurrence after each surgery. On presentation, he reported unintentional 10 kg weight loss over several months and night sweats. Endocrine was consulted for evaluation of hypercalcemia. On examination and imaging, 8.7 x 14.0 x 14.0 cm fungating tumor on the nape of his neck extending to the occipital area and cervical lymphadenopathy were noted. Labs were notable for WBC of 21.7 K/uL, hemoglobin of 6.0 g/dL, calcium of 12.0 mg/dL, albumin of 3.1 g/dL, free calcium of 6.4 mg/dL, corrected calcium of 12.6 mg/dL, phosphorus of 2.6 mg/dL, and intact PTH of < 4 pg/mL. The PTH-related peptide (PTHrP) level was found to be normal at 19 pg/mL (reference range 14–27 pg/mL). SPEP was normal. Neck mass and cervical lymph nodes were biopsied. Histopathological examination of neck mass showed an ulcerated, moderately-differentiated squamous cell carcinoma with multifocal areas of necrosis. There was no evidence of malignancy in the cervical lymph nodes. CT scan showed 3 mm lung nodules, thought to be granulomas, and no clear evidence of metastatic disease. Hypercalcemia was treated with IV hydration and one dose of bisphosphonate and patient underwent resection of neck mass. Immediately after surgery, his calcium level precipitously decreased and has remained normal in the months since surgery. Discussion: Hypercalcemia of malignancy is a common finding affecting up to 44.1% of patients with malignancy (1,2). The major mechanism, accounting for approximately 80% of malignancy-related hypercalcemia, is mediated via PTHrP, which can cause hypercalcemia by increasing bone resorption and renal tubule calcium reabsorption (2). Squamous cell carcinoma (SCC), especially of the lungs, breast, or GI tract, is more frequently associated with hypercalcemia. There are also several case reports of primary cutaneous SCC associated with hypercalcemia. In these cases, tumors were large and hypercalcemia was thought to be due to elevated PTHrP (3,4,5). The skin has been shown to express PTHrP and PTHrP receptors (10). PTHrP has also been detected in 100% of cutaneous SCCs even in the absence of hypercalcemia. (6,7). Furthermore, PTHrP mRNA has been localized in 100% of squamous tumors with hypercalcemia and PTHrP peptide were detected in 91% of cases in a study of 11 patients (9). The patient presented in this case did not have an elevated level of PTHrP. However, resolution of hypercalcemia with resection of the mass supports a diagnosis of hypercalcemia of malignancy. This case illustrates that hypercalcemia due to primary cutaneous SCC typically, but not always, results in an elevated serum PTHrP level.

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Case Report: Kikuchi-Fujimoto Disease: A case of supraclavicular lymphadenopathy

F1000Research ◽

10.12688/f1000research.19981.1 ◽

2019 ◽

Vol 8 ◽

pp. 1652

Author(s):

Shiza Sarfraz ◽

Hamza Rafique ◽

Hassam Ali ◽

Syed Zawahir Hassan

Keyword(s):

Infectious Disease ◽

Case Report ◽

Lymph Nodes ◽

Cervical Lymphadenopathy ◽

Tuberculous Lymphadenitis ◽

Histiocytic Necrotizing Lymphadenitis ◽

Supraclavicular Lymph Nodes ◽

Necrotizing Lymphadenitis

Kikuchi-Fujimoto Disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of cervical lymphadenopathy. Patients usually present with localized lymphadenopathy, fever and fatigue. Because of the poorly understood etiology, it can be mistaken for an infectious disease or even malignance. Here we discuss a case of KFD that initially presented with left sided cervical lymphadenopathy that later progressed to left supraclavicular lymph nodes. Due to its characteristic overlap with other disorders like tuberculous lymphadenitis and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, one should be made aware of symptoms that can lead to misdiagnosis in patients.

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Role of FNAC in the diagnosis of cervical lymphadenopathy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175383 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5237

Author(s):

Chandralekha Janagam ◽

Bhagyalakshmi Atla

Keyword(s):

Cervical Lymphadenopathy ◽

Needle Aspiration ◽

Clinical Findings ◽

Common Disease ◽

Tuberculous Lymphadenitis ◽

Age Group ◽

Cervical Lymph Nodes ◽

Specific Distribution ◽

Neoplastic Lesions ◽

Granulomatous Lymphadenitis

Background: Cervical lymphadenopathy is one of the commonest presentations in inflammatory and neoplastic disorders. Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive OPD technique used for establishing the etiology of cervical lymphadenopathy. In this study we describe cytomorphological patterns of cervical lymph nodes and its utility in establishing diagnosis. Objectives of present study were to assess the distribution of various cytomorphological patterns of cervical lymphadenopathy and to assess the age specific distribution of various cytomorphological patterns of cervical lymphadenopathy.Methods: This study was carried out in the Department of Pathology, Andhra Medical College on 200 cases of cervical lymphadenopathy over a period of three months from August - October 2017. FNAC diagnosis was correlated with relevant clinical findings and investigations.Results: Total 200 cases were studied. Of these, 170 (85%) were inflammatory and 30 (15%) were neoplastic. Reactive non-specific lymphadenitis was the most common disease found in 95 (47.5%) patients followed by tuberculous lymphadenitis in 60 patients (30%) and granulomatous lymphadenitis in 15 patients (7.5%). Among neoplastic lesions, metastatic tumours were reported in 26 patients (13%) and Lymphoproliferative disorder/Lymphoma was reported in 4 patients (2%). Highest incidence of cervical lymphadenopathy was found in patients of 10-39 years age group, among which most of the cases were non-specific lymphadenitis followed by tuberculous lymphadenitis. Amongst the neoplastic lesions, most of the cases were in the age group of 40-79 years.Conclusions: FNAC is simple, safe, reliable procedure for diagnosis of cervical lymphadenopathy.

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Case Report: Kikuchi-Fujimoto Disease: A case of supraclavicular lymphadenopathy

F1000Research ◽

10.12688/f1000research.19981.2 ◽

2021 ◽

Vol 8 ◽

pp. 1652

Author(s):

Shiza Sarfraz ◽

Hamza Rafique ◽

Hassam Ali ◽

Syed Zawahir Hassan

Keyword(s):

Infectious Disease ◽

Case Report ◽

Lymph Nodes ◽

Cervical Lymphadenopathy ◽

Tuberculous Lymphadenitis ◽

Histiocytic Necrotizing Lymphadenitis ◽

Supraclavicular Lymph Nodes ◽

Necrotizing Lymphadenitis

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Causes and Presentation Of Cervical Lymphadenopathy

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.4-2.21 ◽

2018 ◽

Vol 4 (2) ◽

pp. 31-35

Author(s):

Arifullah Bangash ◽

Syed Zafar Hassan ◽

Ghulam Muhammad

Keyword(s):

Lymph Nodes ◽

Teaching Hospital ◽

Acute Inflammation ◽

Cervical Lymphadenopathy ◽

Excisional Biopsy ◽

Descriptive Study ◽

Lymph Node Involvement ◽

Cervical Lymph Nodes ◽

Node Involvement ◽

Reactive Hyperplasia

OBJECTIVETo determine the proportion of cervical lymphadenopathy in systemic diseases, their presentation and investigative tools.METHODOLOGYThis descriptive study was carried out from 1st July 2014 to 30 June 2017 in ENT and head and neck department Naseer Teaching Hospital and Town Teaching Hospital, Peshawar. Total of 270 patients with enlarged cervical lymph nodes, of either sex and of any age were approached for inclusion into the study. Patients with suspected acute inflammation were given a trial of antibiotic and followed for two weeks were excluded from the study. Excisional biopsy of the lymph nodes was performed in all these patients with six weeks or more duration.RESULTSIn our study out of 270 patients, 158 (58.5%) were males and the majority of patients (63.3%) had ages from 11-40 years. Tuberculous cervical lymphadenopathy was diagnosed in 145 (53.7%) patients, reactive hyperplasia in 53 (19.6%), lymphoma in 32 (11.8 %,) metastasis to cervical lymph nodes in 30 (11.1%), sarcoidosis in 7 (2.6%) and other very rare conditions as Kawasaki, Kikuchie and Rosi Dorfman were found in only one of each (0.4%). About 136 (50.4%) of the patients had involvement of multiple lymph nodes while 134 (49.6%) had single swelling. The matted lymph nodes were found in 162 (60%) whereas discrete lymph nodes were found in only 108 (40%) cases. Cold abscess was found in 19 (7%) of patients.CONCLUSIONTuberculosis is the commonest cause of cervical lymphadenopathy, with the majority of these patients having multiple lymph node involvement. In children, usually cervical lymphadenopathy is reactive or infective while in older age mostly metastatic.

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Kikuchi Disease in Korean Children: Clinical Features and Disease Courses.

Blood ◽

10.1182/blood.v110.11.2285.2285 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2285-2285 ◽

Cited By ~ 1

Author(s):

Jun Eun Park ◽

Hyun Joo Jung ◽

Chul-Ho Kim ◽

Jeong Hong ◽

Jae Ho Han

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Medical Center ◽

University Hospital ◽

First Episode ◽

Excision Biopsy ◽

Cervical Lymph Nodes ◽

Korean Children ◽

Presenting Symptoms

Abstract OBJECTIVES: Kikuchi’s disease (KD) is a benign, self-limiting disorder of unknown origin with lymphadenopathy and fever, and prevalent in young Asian women. The initial presentations mimic malignancies or other serious infections, and the biopsy of lymph nodes affected is the only definite diagnostic tool of KD. We analyzed data from a series of pediatric cases collected at a single medical center and suggest proper guideline of management for patients with KD. METHODS: The medical records of children under 16 years of age, who underwent lymph node biopsies and received histiopathologic diagnosis of KD at Ajou University Hospital, South Korea from January 2000 to June 2007, were retrospectively reviewed. RESULTS: Twenty six pediatric patients with KD included 10 boys and 16 girls. In all cases except two, the cervical lymph nodes were involved. Twenty (76.9%) patients had fever as a presenting symptom, and 5 patients (19.2%) had various skin rash. Leukopenia was noted in 8 cases (30.8%), but there was no case of leukocytosis. The levels of ESR and LDH were slightly elevated, but CRP and liver enzymes were within normal range. No KD patients in this study developed any other autoimmune disorders during follow-up period. Eleven (55%) cases with fever improved immediately after excision biopsy of affected lymph nodes. Eight (30.8%) cases treated with steroid showed dramatic responses. Six patients (23.1%) had resolutions of symptoms simply with symptomatic treatments. The recurrence happened in 6 (23.1%) children within a few weeks from the first episode. CONCLUSIONS: Contrary to previous reports on Asian cases, KD in Korean children is not rare in young boys, and fever is more common presenting symptoms. It’s relationship with autoimmune diseases or infection of EBV is not clear. Symptoms such as fever improved in some cases only by the removal of affected lymph node for excision biopsy. In agreement with previous reports, patients treated with steroid recovered dramatically. Therefore, we suggest an earlier excision biopsy for patients suspicious with KD and an immediate treatment of cases with severe symptoms with steroid. The recurrence rate in this study was higher than that in previous studies, therefore, a spell of follow-up period after disappearance of symptoms is advisable for patients with original diagnosis of KD.

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The Clinical and Histological Characterization of Malignant Lymphoma, Kikuchi-Fujimoto Disease and L-Forms Acid-Fast Bacillus Infection

Blood ◽

10.1182/blood.v112.11.5275.5275 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5275-5275

Author(s):

Jie He ◽

Rui-ping Li ◽

Jian-hua Wang ◽

Bao-An Chen

Keyword(s):

Lymph Nodes ◽

Malignant Lymphoma ◽

Antibiotic Treatment ◽

Acid Fast Bacillus ◽

Cervical Region ◽

Excision Biopsy ◽

Cervical Lymph Nodes ◽

Inappropriate Treatment ◽

Acid Test

Abstract Objective: Malignant lymphoma (ML), Kikuchi-Fuljimoto disease (KFD) and L-forms Acid-fast bacillus infection (L-forms TB) usually affect the cervical lymph nodes. KFD and L-form TB are often confused with ML and take misdiagnosis and inappropriate treatment. The diagnosed of these diseases is on basis of an excision biopsy of affected lymph nodes. Methods: We analyzed 63 patients (including case diagnosed in our hospital) by clinical characteristic, laboratory, pathological morphology, histochemistry and immunohistochemistry. Results: Of 63 cases, 43 were ML, 17 were KFD and 3 were L-forms TB. In ML disease, 46% were male and 54% were female, mean age was 54 (11–82). 9% cases have persistent fever and associated with hepatosplenomegaly. In KFD, 47% were male and 53% were female, mean age was 26 (17–45). 59% cases with cervical hymphadenopath and no fever, 41% had painful, accompanied by fever. hepathosplenomegaly, occasionally leucopenia and lypadenopathy especially involving cervical region not responsive to antibiotic treatment. 29% lymph tissues were morphologically, and characterized by a necrosis in the cortical or paracortical areas of enlarged lymph node around the necrotic area. T lymphocytes were found and absence of granulocytes. 30% cases were mistaken to ML. L-forms TB disease, there were fever, clinical and histological were similar KFD and ML. 3 cases were misdiagnosis to ML or KFD. Laboratory analyses: PAM and PAS were positive, and anti acid test to found L-forms bacterium in tissues. Conclusions: Kikuchi-Fujimoto disease and L-forms Acid-Fast bacillus infection are easily confused histological and clinically with malignant lymphoma. Clinicians and pathologists must be aware of this condition. Although Malignant lymphoma, Kikuchi-Fujimoto disease and L-forms Acid-fast bacillus infection can be found any age, but should be considered for malignant lymphoma in older patients. Kikuchi-Fujimoto disease is predominantly a self-limiting disease of the young and most cases with fever, nodal biopsy showing fragmentation necrosis and karyorrhexis, not responsive to antibiotic treatment. In the L-forms Acid-fast bacillus infection, the PAM and PAS are positive, and have an effective antibiotic treatment.

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