scholarly journals Metastatic cervical lymphadenopathy masquerading as extrapulmonary tuberculosis

2012 ◽  
Vol 18 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Adebolajo A Adeyemo

Introduction: Cervical lymphadenopathy can be due to various pathologies especially in the young. A high index of suspicion is required in the management of cervical lymphadenopathy to prevent misdiagnosis and wrong treatment.Case report: Here present the diagnostic challenge in the case of a young lady with nasopharyngeal carcinoma who initially presented solely with cervical lymphadenopathy. Previous fine needle aspiration cytology had suggested tuberculosis (TB) and she was commenced on anti-TB drugs. However failure of improvement and worsening symptoms led to another review in ENT clinic. A subsequent nasopharyngeal biopsy confirmed nasopharyngeal carcinoma. She subsequently improved after commencement of appropriate treatment.Conclusion: In regions with a high prevalence rate of tuberculosis, care must be taken to exclude malignancy in patients with cervical lymphadenopathy even when cytology suggests a granulomatous infection. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12030 Bangladesh J Otorhinolaryngol 2012; 18(2): 234-237

Author(s):  
Majid Ali Sarfraz ◽  
Apurva Raina ◽  
Deepjyoti . ◽  
Arti .

<p class="abstract"><strong>Background:</strong> Tuberculosis (TB) of head and neck is a rare form of extrapulmonary TB but still poses a significant clinical and diagnostic challenge. Rare occurrence and unspecific symptoms of extrapulmonary tuberculosis often leads to misdiagnosis. The aim of the study was to evaluate the various otolaryngological manifestations of extrapulmonary TB and make otolaryngologist aware of these manifestations.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 40 cases who presented to us at a tertiary hospital with various symptoms of head and neck TB. Detailed history with ear, nose throat examination was carried out on all patients. Fine needle aspiration cytology (FNAC), histopathology and Acid-fast bacilli (AFB) staining were done to confirm the diagnosis. After confirmation, patients were started on anti-TB therapy and showed good response to the treatment.  </p><p class="abstract"><strong>Results:</strong> The study included 40 cases who presented to us at a tertiary hospital with various symptoms of head and neck tuberculosis. The majority of these cases had cervical lymphadenopathy (55%) followed by deep neck abscess (20%), laryngeal TB (15%), tubercular otitis media (7.5%) and nasal TB (2.5%). Majority of the cases (65%) belonged to lower socio-economic status. 42.5% of cases had family history of pulmonary TB. Six out of 40 subjects had co-existing pulmonary TB.</p><p class="abstract"><strong>Conclusions:</strong> Otorhinolaryngeal TB can involve any site with unspecific symptoms. The most commonly site involved is cervical lymph node presenting as neck swelling. Variable nature of its manifestations makes it necessary to have high degree of clinical suspicion to make early diagnosis.</p>


2008 ◽  
Vol 123 (7) ◽  
pp. 764-767 ◽  
Author(s):  
R Khan ◽  
S H Harris ◽  
A K Verma ◽  
A Syed

AbstractBackground:The commonest form of extrapulmonary tuberculosis is tubercular cervical lymphadenitis, or scrofula.Methods and results:A total of 1827 patients with cervical lymphadenopathy who presented to various out-patients clinics of our institution were studied over a three-year period. Eight hundred and ninety-three (48.87 per cent) of these patients had lesions of tubercular origin. The most common observation was unilateral, matted adenopathy in female patients aged between 11 and 20 years and without constitutional symptoms of tuberculosis. Posterior triangle nodes were affected in 43.8 per cent of cases, followed by upper deep cervical nodes in 33.9 per cent. Fine needle aspiration cytology constituted the main diagnostic tool, with a positive yield in 90 per cent of patients. Polymerase chain reaction analysis was performed in 126 patients, with a sensitivity of 63 per cent. Only 18 per cent of patients had associated pulmonary tuberculosis, the rest having isolated involvement of cervical nodes. Medical treatment with anti-tubercular drugs for a period of six months formed the mainstay of treatment and cure. Surgical management was reserved for selected refractory patients.Conclusion:Tubercular cervical lymphadenitis can readily be diagnosed by fine needle aspiration cytology, a simple and cost-effective test. The disease can be cured completely by a short course of anti-tubercular chemotherapy, without surgical intervention.


2011 ◽  
Vol 2011 ◽  
pp. 1-2
Author(s):  
Sameer Singhal

Primary extrapulmonary tuberculosis occurring in the breast is extremely rare. In the absence of well-defined clinical features, the true nature of the disease remains obscure and it is often mistaken for carcinoma or pyogenic breast abscess. It also presents a diagnostic problem on radiological and microbiological investigations and thus high index of suspicion acquires an important position. This paper highlights the importance of considering every breast lump as a potential case of tubercular mastitis especially in endemic countries like India that should be subjected to fine needle aspiration cytology or excisional biopsy before considering surgical options like complete mastectomy, without relying only on clinicoradiological findings.


2010 ◽  
Vol 125 (1) ◽  
pp. 70-77 ◽  
Author(s):  
S-T Toh ◽  
H-W Yuen ◽  
K-H Lim ◽  
Y-H Goh ◽  
H-K C Goh

AbstractBackground:Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem.Methods:We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results.Results:The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease.Conclusion:In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.


2017 ◽  
Vol 8 (3) ◽  
pp. 72-75
Author(s):  
Amit Gupta ◽  
Lovenish Bains ◽  
Deepshikha Yadav ◽  
Prashant Durgapal ◽  
Manish Kumar Agrawal

Background: Tuberculous mastitis (TM) is a rare extra pulmonary presentation of tuberculosis. It may be problematic to distinguish from carcinoma breast, a condition with which it may coexist.  Fine needle aspiration cytology (FNAC) / biopsy are indispensable for diagnosis and tuberculosis culture when positive may be very valuable to guide antimicrobial therapy.Aims and Objectives:  To disseminate the message to the concerned expertise that it can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed.Materials and Methods: 19 cases of tubercular mastitis between  January 2012 to March 2014 were identified and included in the present study. Cytology and biopsy alongwith AFB stain was done for confirmation.Results: Age ranged between 23- 55 years (median 33 years). Axillary nodes were palpable in 9 (47.3%) patients. Acid Fast Bacilli stain which was positive in only 3 patients. All the 19 patients were started on antitubercular treatment.Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease.Asian Journal of Medical Sciences Vol.8(3) 2017 72-75


2017 ◽  
Vol 4 (12) ◽  
pp. 3967
Author(s):  
Narender N. R. ◽  
Yadagiri Rao J.

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. 


Author(s):  
Nitin Sharma ◽  
Maya Singh ◽  
Pritosh Sharma ◽  
Rahul Nahar ◽  
V. P. Goyal

<p class="abstract"><strong>Background:</strong> Cervical lymphadenopathy is the sign of a disease process which involves lymph nodes that are anomalous in uniformity and dimensions. It is very vital to exercise fine-needle aspiration biopsy, histopathological investigation, and ultrasonography for the diagnosis of palpable lesions.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 12-month duration from January 2018 to December 2018 in 61 patients presenting with cervical lymphadenopathy admitted in the ENT Department at Geetanjali Medical College and Hospital, Udaipur.  </p><p class="abstract"><strong>Results:</strong> In biopsy, most common diagnosis was chronic granulomatous lymphadenitis i.e. in 62.3% of the patients. As compared to biopsy, fine-needle aspiration cytology (FNAC) showed chronic granulomatous lymphadenitis in 46% of the patients, with overall sensitivity of 91.1%, and specificity of 60.0%. and accuracy of 88.5%. Whereas ultrasonography (USG) reported, 64% cervical lymphadenopathy in patients, with overall sensitivity came out to be 91.1%, specificity to be 40.0%, accuracy was 86.9%.</p><p class="abstract"><strong>Conclusions:</strong> Present study showed that biopsy is the gold standard procedure for diagnosis of cervical lymphadenopathy lesions followed by FNAC, USG. Tuberculous lymphadenitis was most common diagnosis made by the diagnostic modalities.</p>


2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Dimitrios Anyfantakis ◽  
Ageliki Damianaki ◽  
Maria Kokosi ◽  
Emmanouil K. Symvoulakis ◽  
Serafim Kastanakis

An 83-year-old Caucasian Greek man was referred by his general practitioner to the emergency department of the general hospital in Crete because of seizures and agitation. His past medical history was negative for any neurological or medical condition. Electroencephalogram showed a bradyarrhythmic theta activity, without evidence of any focal or other specific abnormality. Magnetic resonance imaging of the brain demonstrated a number of diffuse nodular lesions and moderate perivascular edema. An axillary lymph node fine needle aspiration cytology suggested a granulomatous lymphadenitis along with signs of tuberculous infiltration. Tuberculin skin test was positive. We report a rare case of extrapulmonary tuberculosis mimicking brain metastatic lesions.


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