Tuberculosis and Lymphadenopathy

5/10/00 (Doyle)

Group: Wednesday Residents

RE: A 30 year old male with 1-month history of fatigue, double vision, and headache.

Question: What are aspects of lymphadenopathy in tuberculosis?

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Unique Identifier: 99190305

Authors: Fain O. Lortholary O. Djouab M. Amoura I. Babinet P. Beaudreuil J. Boudon P. Desrues J. Glowinski J. Lhote F.: Malbec D. Mathieu E. White C. Guillevin L. Thomas M.

Institution: Department of Internal Medicine, Jean Verdier Hospital, Bondy, France.

Abstract: We report 59 cases of lymph node tuberculosis in adults not infected by the human immunodeficiency virus (HIV),: observed over a period of 5 years in the North Eastern suburbs of Paris. There were 31 women and 28 men; 84.7%: were aged under 44 years; 69.5% were not French, and 78% had exclusive lymph node tuberculosis. A superficial: distribution was found in 52 cases and a deep pattern in 17 cases. Cervical and supraclavicular lymphadenopathies: were the most common (64.4%). General symptoms were present in 63% of cases. The diagnosis was established by: fine needle aspiration in 10 cases and by biopsy in 36 cases. Three cases of primary resistance to anti-tuberculosis: therapy were described. Lymph node tuberculosis is still present in the Paris region, independently of HIV infection,: probably due to poor social conditions.

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Unique Identifier: 99161610

Authors: Yang ZG. Min PQ. Sone S. He ZY. Liao ZY. Zhou XP. Yang GQ. Silverman PM.

Institution: Department of Radiology, First University Hospital, West China University of Medical Sciences, Chengdu, Sichuan.

Abstract: OBJECTIVE: Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study: evaluated specific CT imaging criteria for differentiating these entities. MATERIALS AND METHODS: We: retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 (38%) with: tuberculosis and 43 (62%) with untreated lymphomas involving abdominal lymph nodes. Of the patients with: tuberculosis, five (19%) had disseminated disease and 21 (81%) had nondisseminated disease. Of the patients with: lymphomas, 16 (37%) had Hodgkin's disease and 27 (63%) had non-Hodgkin's lymphoma. RESULTS: Disseminated: and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper: paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease (15 patients: [94%]), non-Hodgkin's lymphoma (24 patients [89%]), and disseminated tuberculosis (five patients [100%]) than in: nondisseminated tuberculosis (one patient [5%]). Mesenteric lymph nodes were involved more often in disseminated: tuberculosis (four patients [80%]) and nondisseminated tuberculosis (11 patients [52%]) than in Hodgkin's disease: (one patient [6%]) (p < .01). Anatomic distribution was not different between disseminated tuberculosis and: non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a: multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation (14: patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]).: CONCLUSION: Our findings indicate that the anatomic distribution and specific enhancement patterns of: lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated: lymphomas of the abdominal lymph nodes.

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Unique Identifier: 98456573

Authors: Ying M. Ahuja AT. Evans R. King W. Metreweli C.

Institution: Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, New Territories, Hong: Kong.

Abstract: PURPOSE: Clinical examination alone cannot differentiate between cervical tuberculous lymphadenitis and cervical: nodal metastases from non-head and neck (NHN) carcinomas because the distributions of involved lymph nodes are: similar. We evaluated the sonographic features of cervical lymph nodes that could be used to differentiate between the 2: categories of nodes. METHODS: We retrospectively reviewed sonograms of abnormal cervical lymph nodes in 47: patients with proven cervical tuberculous lymphadenitis and in 22 patients with proven nodal metastases from NHN: carcinomas. RESULTS: Abnormal nodes in tuberculous lymphadenitis and nodal metastases from NHN carcinomas: were commonly found in the supraclavicular fossa (15% and 38%, respectively) and the posterior triangle (70% and: 41%, respectively). Statistically significant (p < 0.05) features for differential diagnosis were lymph nodes' longest: diameter, echogenicity, short-to-long axis ratio, appearance of surrounding soft tissues, and presence of intranodal cystic: necrosis, matting, and posterior enhancement. Nodal size, echogenicity, presence of an echogenic hilum, calcification,: coagulation necrosis, and sharpness of borders helped in identifying the abnormal lymph nodes. CONCLUSIONS:: Sonographic features that helped to differentiate between the 2 categories of nodes were shape, edema of surrounding: soft tissue, homogeneity, intranodal cystic necrosis, matting, and posterior enhancement.

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Unique Identifier: 98304132

Authors: Hainaut P. Monthe A. Lesage V. Weynand B.

Institution: Service de Medecine Interne Generale, Cliniques Universitaires St Luc, Bruxelles.

Abstract: We report about 2 cases of isolated mediastinal tuberculous lymphadenitis presenting without parenchymal infiltrates.: Although rare, this mode of presentation reminds the clinician that tuberculosis has to be included in the differential: diagnosis of mediastinal masses even in the absence of parenchymal lesion. Both cases illustrate the value of: mediastinoscopic examination to assess the diagnosis.

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Unique Identifier: 97275662

Authors: Na DG. Lim HK. Byun HS. Kim HD. Ko YH. Baek JH.

Institution: Department of Radiology, Samsung Medical Center, Seoul, Korea.

Abstract: OBJECTIVE: The purpose of this study was to evaluate the usefulness of color Doppler sonography in differentiating: benign from malignant cervical lymphadenopathy. MATERIALS AND METHODS: We used color Doppler: sonography to evaluate 117 lymph nodes in 105 patients. The patients were pathologically and clinically confirmed to: have benign reactive lymphadenitis (n = 28), tuberculosis (n = 17), lymphoma (n = 14), and metastasis (n = 46). The: patterns of hilar vascularity, central nodal vascularity, and peripheral vascularity were assessed. The highest resistive: index and pulsatility index in 116 lymph nodes were measured from spectral waveforms. Histologic findings of nodal: vessels were analyzed in 14 nodes and compared with findings on color Doppler sonograms. RESULTS: Thirty-two: (94%) of 34 nodes with benign reactive disease showed normal patterns of nodal vascularity; central hilar vascularity,: radial symmetric central vascularity, and no peripheral vascularity. At least one of six abnormal patterns of vascularity: (eccentric or absent hilar vascularity; deformed radial, aberrant multifocal, or absent central vascularity; and peripheral: vascularity) was observed in 98% (65/66) of nodes with malignant disease and in all tuberculous nodes. We established: cutoff values of 0.8 for the resistive index and 1.5 for the pulsatility index that were 100% specific for malignancy.: However, sensitivities for these cutoff values were 47% and 55%, respectively. Also, histologic examinations showed: that most flow signals in nodes with malignant disease represented arterioles or veins in the septa between tumor nests or: near the capsule. CONCLUSION: Unlike nodes with benign reactive disease, 98% of nodes with malignant disease and: 100% of tuberculous nodes showed abnormal patterns of nodal vascularity. Also, high values for the resistive and: pulsatility indexes were highly specific for malignant lymphadenopathy. Color Doppler sonography combined with: analysis of spectral waveforms was useful in differentiating benign from malignant cervical lymphadenopathy.

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Unique Identifier: 97145111

Authors: Fitzpatrick EL. LeJeune FE Jr.

Institution: Dept of Otolaryngology, Head and Neck Surgery, Tulane University School of Medicine, New Orleans, USA.

Abstract: Over the last decade mycobacterial infections have been shown to be on the rise in the United States and worldwide.: The diagnosis of mycobacterial cervical lymphadenitis, otherwise known as scrofula, should thus be entertained when: faced with the hallmark presentation of chronic, nontender cervical lymphadenopathy. This article reviews current: epidemiology, bacteriology, diagnostic techniques, and treatment options for tuberculous and nontuberculous: mycobacterial cervical lymphadenitis. [References: 12]

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Unique Identifier: 96264413

Authors: Baran R. Tor M. Tahaoglu K. Ozvaran K. Kir A. Kizkin O. Turker H.

Institution: Department of Pulmonary Diseases, Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.

Abstract: BACKGROUND: Whilst intrathoracic lymphadenitis is a characteristic sign of primary tuberculosis in children, its: presence without parenchymal lesions in adults is unusual and makes the diagnosis using noninvasive techniques difficult.: The diagnostic role of bronchoscopy in adults with intrathoracic tuberculous lymphadenitis is reported. METHODS:: Seventeen patients with intrathoracic lymphadenopathy seen during 1993 who had all undergone bronchoscopy and had: been found to have tuberculosis in the absence of any parenchymal lung lesions were evaluated retrospectively.: RESULTS: Right paratracheal lymphadenopathy was observed on the plain chest radiograph in all the patients. Fifteen: of the 17 patients had an endobronchial abnormality and samples taken at bronchoscopy gave a definitive diagnosis in: nine (53%) of the 17. Four patients had ulcerating endobronchial granuloma and all had biopsy samples positive for: tuberculosis. Transbronchial or transcarinal needle aspiration samples were diagnostic in five of 11 patients (45%): subjected to the procedure. Peripheral lymph node biopsy diagnosed tuberculosis in two cases and in the remaining six: patients the diagnosis wa achieved by mediastinoscopy or thoracotomy. CONCLUSIONS: Bronchoscopy has an: important role in the diagnosis of intrathoracic tuberculous lymphadenopathy in adults and should be considered before: other invasive procedures.

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Unique Identifier: 96264054

Authors: Bem C. Patil PS. Bharucha H. Namaambo K. Luo N.

Institution: School of Medicine, University of Zambia, Republic of Zambia.

Abstract: The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients: presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing: superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of: HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990,: 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV: lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive: in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63: of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's: disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology: was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded: that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients: presenting for lymph node biopsy in Central Africa.

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Unique Identifier: 96185175

Authors: Al-Attia HM. Shanaa ZA. Knox-Macaulay HH.

Institution: Department of Internal Medicine, Mafraq Hospital, Abu Dhabi, UAE.

Abstract: A 46-year-old man with fever and pancytopenia was found to have a myelodysplastic syndrome. During the course of: the illness, he had localized cervical tuberculous lymphadenitis. We believe this association of the myelodysplastic: syndrome with localized tuberculosis has not been previously described.

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Unique Identifier: 96091563

Authors: Perenboom RM. Richter C. Swai AB. Kitinya J. Mtoni I. Chande H. Kazema RR.

Institution: Department of Medicine, Muhimbili Medical Centre, Dar es Salaam, Tanzania.

Abstract: SETTING: The medical wards of a referral hospital in Dar es Salaam, Tanzania. OBJECTIVE: To investigate the: impact of HIV infection on clinical features in tuberculous lymphadenitis. DESIGN: A prospective clinical study of HIV: seropositive and HIV seronegative patients with lymphadenopathy. RESULTS: Of 128 patients with peripheral: lymphadenopathy, 24 had no tuberculosis (TB) and in 10 patients TB was found only in other organs. The remaining: 94 patients, of whom 76% were HIV seropositive, formed our study population. TB lymphadenitis was considered: proven in 89 and probable in 5 patients. Disseminated TB (both TB adenitis and TB in other organs) was diagnosed: more often in HIV seropositive than in HIV seronegative patients (52% versus 26%, P < 0.03). 59% of the 71: HIV-infected patients compared to only 4% of the 23 patients without HIV infection were over 30 years of age (P <: 0.02). The following clinical features were significantly associated with HIV infection: dyspnoea, respiratory rate >: 20/min, low motility score (bedridden), neurological abnormalities, hepatomegaly, splenomegaly, lymph node size < 2.5: cm, negative PPD skin test, lymphopenia (< 1000/cm3) and presence of pleural fluid. CONCLUSION: Co-infection: with HIV influences several clinical and laboratory features in patients with tuberculous lymphadenitis.

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Unique Identifier: 96072684

Authors: Jain R. Sawhney S. Bhargava DK. Berry M.

Institution: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Abstract: OBJECTIVE. The diagnosis of abdominal tuberculosis is often difficult, because clinical manifestations and results of: laboratory studies are nonspecific. If sonographic findings are sufficiently characteristic for diagnosis, sonography would: be useful, especially in India, where abdominal tuberculosis is common and more expensive imaging techniques are not: easily available. Accordingly, we performed sonography to establish the sonographic findings in cases of early: tuberculosis in 56 patients with abdominal tuberculosis who had normal barium studies of the small bowel.: SUBJECTS AND METHODS. Fifty-six patients with clinical features suggestive of abdominal tuberculosis (history of: fever, abdominal pain, and weight loss) with no history of intestinal obstruction and normal barium studies of the small: bowel had abdominal sonography. All sonograms were independently assessed by three radiologists, and the findings: were tabulated by consensus. Diagnosis of tuberculosis was confirmed by sonographically guided biopsy of mesenteric: lymph nodes in 19 patients, analysis of aspirated ascitic fluid in 12, and response to antituberculous chemotherapy in 25.: Sonography was repeated 1, 3, 6, and 12 months after antituberculous chemotherapy was begun. Abdominal sonograms: were also performed in 30 healthy volunteers, and measurements of mesenteric thickness were recorded. The mesenteric: thickness was statistically compared in two groups of patients: patients at presentation with patients at the end of: antituberculous chemotherapy and patients at presentation with healthy individuals. RESULTS. The mesenteric thickness: in healthy individuals ranged from 5 to 14 mm. Sonographic findings in all patients with abdominal tuberculosis included: an echogenic thickened mesentery (> or = 15 mm) with mesenteric lymphadenopathy. Other findings were dilated small: bowel loops in 38 patients, minimal ascites in 17, matted small bowel loops in five, and omental thickening with altered: echogenicity in three. Regression of these changes was noted on follow-up of all patients undergoing treatment.: CONCLUSION. The characteristic sonographic features of early abdominal tuberculosis are mesenteric thickness of: 15 mm or more and an increase in the mesenteric echogenicity (due to fat deposition), combined with mesenteric: lymphadenopathy. Presence of dilated small bowel loops and ascites further substantiate the diagnosis.

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Unique Identifier: 95159217

Authors: Perenboom RM. Richter C. Swai AB. Kitinya J. Mtoni I. Chande H. Kazema RR. Mwakyusa DH. Maselle SY.

Institution: Department of Medicine, Muhimbili Medical Centre, Dar es Salaam, Tanzania.

Abstract: In order to evaluate procedures leading to the diagnosis of tuberculous lymphadenitis, a prospective clinical study was: carried out of patients with lymphadenopathy admitted to the medical wards of a referral hospital in Tanzania. The yield: of diagnostic procedures (direct auramine/Ziehl-Neelsen (ZN) stained smears, Lowenstein-Jensen (LJ) cultures, cytology: and histological examinations of fine needle aspirations (FNA) and biopsy material of lymph nodes, respectively, was: compared. We also tried to identify clinical diagnostic markers. One hundred and twenty-eight (99 HIV-seropositive): patients were included. In 89 (67 HIV-positive) patients TB lymphadenitis could be proven. Histology and LJ culture of: a lymph node biopsy had the highest diagnostic yield, 85% and 88% respectively, followed by detection of acid-fast: bacilli (AFB) in biopsy smear (53%) and in fine-needle aspirations (35%). The diagnostic yield of the several procedures: was not affected by associated HIV infection. Macroscopic caseation was 100% predictive for TB with a sensitivity of: 69%. Firm and matted lymph nodes, ESR > 100 mm/hr, a positive PPD skin test and pleural opacity on a chest x-ray: proved to be independent predictors for TB. Retrospective testing of a stepwise diagnostic approach based on direct: smears of FNA, macroscopic visible caseation and direct smear of biopsy tissue, suggests that in 93% of the patients a: definite diagnosis of TB lymphadenitis could have been made. Our data suggest that in HIV/TB epidemic areas most of: the cases of TB lymphadenitis can be diagnosed correctly by simple and cheap methods which are generally available at: district hospitals. Our findings need further prospective validation, however.

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Unique Identifier: 95044449

Authors: Khan J. Akhtar M. von Sinner WN. Bouchama A. Bazarbashi M.

Institution: Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Abstract: Twenty-two patients with mediastinal tuberculosis were reviewed. The most common symptoms were chest pain,: cough, fever, and weight loss. Results of the physical examination were unremarkable. The chest radiographs of all 22: patients showed abnormal mediastinum with no evidence of extramediastinal disease. Most (62%) had right-sided: paratracheal lymphadenopathy. Mantoux skin test was positive (> 15 mm) in all patients, whereas sputum smears and: cultures for acid-fast bacilli were negative. Computed tomographic (CT) guided fine needle aspiration biopsies (FNAB): were performed in 12 patients using 22- to 25-gauge needles. Ten patients had fiberoptic bronchoscopic (FOB): examination with brushings and biopsies. Mediastinoscopy (n = 8) or thoracotomy (n = 6) was performed in patients: where either FNAB or FOB was not diagnostic or where lymphoma was suspected clinically. The rates of true-positive: diagnoses were 20%, 66%, 75%, and 100% for FOB, FNAB, mediastinoscopy, and thoracotomy, respectively. The: rate of false-negative for FNAB was 34%. Only one patient developed nonsignificant pneumothorax after FNAB. These: findings suggest that CT-guided FNAB is a useful and safe procedure and should be considered in the initial evaluation of: patients suspected of having mediastinal tuberculosis.

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Unique Identifier: 94351205

Authors: Dasgupta A. Ghosh RN. Poddar AK. Mukherjee C. Mitra PK. Gupta G. Ganguly U.

Institution: Department of Pathology and Microbiology, RG Kar Medical College, Calcutta.

Abstract: One hundred eighty cases of cervical lymphadenopathy have been studied by fine needle aspiration cytological: examination followed by histopathologic examination of the excised lymph nodes. The diagnostic accuracy was 84.4%: for tuberculous lymphadenitis by fine needle aspiration cytological examination. Observation of caseous necrosis (84.2%): and epithelioid cells (73.6%) were the most characteristic diagnostic features in the aspirated smears. Acid-fast bacilli: were observed in 45.6% cases. Metastatic carcinoma also yielded a high diagnostic accuracy ie, 89%. Fine needle: aspiration cytology has been found to be safe, quick, inexpensive with high diagnostic accuracy in cervical: lymphadenopathy.

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Unique Identifier: 94020885

Authors: Manolidis S. Frenkiel S. Yoskovitch A. Black M.

Institution: Department of Otolaryngology, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

Abstract: Despite the decline of pulmonary tuberculosis in the Western world, the incidence of cervical mycobacterial infections: has remained relatively unaffected. A retrospective review was conducted of 20 patients treated for head and neck: tuberculosis from 1984 to 1991. They were mostly an immigrant group coming from underdeveloped countries close to: the equator. All cases were treated with antituberculous chemotherapy; 18 patients also underwent surgical excision of: their lymphadenopathy. Sixteen patients showed complete response to combined treatment and one relapse was: successfully retreated with antituberculous medication. Three patients died from unrelated causes--two from human: immunodeficiency virus infection and one from nasopharyngeal carcinoma. The most reliable indicator of mycobacterial: infection was the pathologic specimen, making the need for surgical intervention an important diagnostic consideration. As: with other reports, most patients in our series had negative chest x-ray films, variable responses to skin testing, and: negative cultures. The epidemiology, pathogenesis, and management of this disease are discussed. [References: 25]

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Unique Identifier: 93263784

Authors: Hanania N. Hoffstein V.

Institution: St Michael's Hospital, University of Toronto, Ontario.

Abstract: Although tuberculosis is still relatively common in Canada, particularly among recent immigrants, one tends not to: consider it very strongly in the absence of definite pulmonary symptoms and in the face of negative smears of: expectorated sputum and bronchial washings. We present the case of a young immigrant from Ethiopia who presented: with mild constitutional symptoms, bony tenderness of the chest wall, generalized lymphadenopathy, and rib erosions--a: set of features which, in the face of smear-negative sputum and bronchial washings, raised a possibility of lymphoma.: Eventually, diagnosis of tuberculous lymphadenitis and osteomyelitis was established and the patient responded well to: appropriate therapy.

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Unique Identifier: 93057231

Authors: Yates MD. Grange JM.

Institution: Public Health Laboratory, Service Regional Tuberculosis Centre, Dulwich Hospital, London, United Kingdom.

Abstract: STUDY OBJECTIVE--The aim was to detect any changing trends in the nature and incidence of tuberculous: lymphadenitis in southeast England and to determine whether there is any evidence for an increase in this disease that: could be related to HIV infection. DESIGN--Mycobacteria isolated from patients with lymphadenitis in the years 1981: to 1989 were identified. Information was available on the age, sex, and ethnic origin of the patients and the anatomical: site from which the mycobacterium was isolated. SETTING--The Public Health Laboratory Service Regional: Tuberculosis Centre at Dulwich, which receives over 95% of mycobacteria isolated in southeast England. MAIN: RESULTS--From 1980 to 1989, cultures were received from 1817 patients with mycobacterial lymphadenitis: 1677: were M tuberculosis, 25 M bovis, 21 M africanum, and 94 were other (environmental) species. In comparison with a: survey conducted in the same region in 1973-80, the number of ethnic Indian subcontinent patients with lymphadenitis: due to M tuberculosis had dropped by 30% and the number of European patients had dropped by 43% and showed a: continuing decline and a shift towards an older age group. By contrast, there was a 20% increase in the number of cases: due to environmental mycobacteria. The number of species causing such infections had increased and a greater: proportion of patients were adults. Three patients infected by environmental mycobacteria were known to be HIV: positive. CONCLUSIONS--The incidence of lymphadentis due to M tuberculosis is declining but cases due to: environmental mycobacteria are increasing, with a greater diversity of species and more adult patients. There is no: conclusive evidence for an impact of HIV infection on the incidence and nature of mycobacterial lymphadenopathy in: southeast England, but this cannot be ruled out.

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Unique Identifier: 93006963

Authors: Thompson MM. Underwood MJ. Sayers RD. Dookeran KA. Bell PR.

Institution: Department of Surgery, University of Leicester, UK.

Abstract: Peripheral tuberculous lymphadenopathy is the commonest form of extrapulmonary tuberculosis. Sixty-seven patients: with peripheral tuberculous lymphadenopathy who presented to general surgeons and underwent lymph node biopsy: between 1979 and 1989 are reviewed. Fifty-four patients (81 per cent) were of Indian subcontinent ethnic origin and 13: (19 per cent) were of white ethnic origin. The sites most commonly affected were the cervical lymph nodes. Biopsy: specimens obtained by open operation were sent for microbiological examination in all but 13 cases, of whom seven: were patients of white ethnic origin. Tuberculous lymphadenopathy remains an important differential diagnosis of cervical: lymphadenopathy and it is essential that peripheral lymph node biopsies are examined both histologically and: microbiologically.

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Unique Identifier: 92254555

Authors: Gupta AK. Nayar M. Chandra M.

Institution: Department of Surgery, Safdarjang Hospital, New Delhi, India.

Abstract: A cytomorphologic diagnosis of tuberculous lymphadenitis by examination of needle aspirates was made in 560 of 1,471: cases of lymphadenopathy studied over two years. Cytologic features were categorized into four groups: epithelioid: clusters with or without Langhans's giant cells without necrosis (32.14%), epithelioid clusters with or without Langhans's: giant cells with necrosis (50.35%), occasional epithelioid cells without characteristic necrosis/giant cells (2.85%) and: necrosis without epithelioid clusters or Langhans's giant cells (14.64%). While a diagnosis of tuberculous lymphadenitis: was offered with confidence in the first two groups, constituting about 82.49% cases, aspirates from the third- and: fourth-group patients were subjected to Ziehl-Neelsen staining for acid-fast bacilli, which was positive in 12.5% and: 75.6% of cases, respectively.

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Unique Identifier: 91097736

Authors: Lau SK. Wei WI. Kwan S. Yew WW.

Institution: Department of Surgery, University of Hong Kong, Queen Mary Hospital.

Abstract: A prospective study to evaluate the efficacy of combined use of fine-needle aspiration (FNA) cytologic examination and: Mantoux test in the diagnosis of cervical tuberculous lymphadenitis was carried out. Tuberculin reactions were: determined in 59 control subjects. Preoperative FNA cytologic examinations and Mantoux tests were performed on 74: patients with cervical lymphadenopathy. The lymph nodes were then excised and examined histologically and cultured: for mycobacteria. Forty-eight, 22, and 4 patients had histologically confirmed tuberculous, non-specific, and malignant: lymphadenopathy. Fine-needle aspiration cytologic examination alone could detect cervical tuberculous lymphadenitis in: 37 patients (77%). The predictive value of a strong tuberculin reaction for mycobacterial infection was 100%. The: combined use of a Mantoux test and FNA cytologic examination was able to diagnose 43 (90%) of 48 cases of: tuberculous lymphadenitis cervical preoperatively. Combined use of FNA cytologic examination and Mantoux test was: efficient in the diagnosis of tuberculous lymphadenitis.

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Unique Identifier: 90366876

Authors: Dandapat MC. Mishra BM. Dash SP. Kar PK.

Institution: Department of Surgery, M.K.C.G. Medical College, Orissa, India.

Abstract: One hundred and ninety-two patients with peripheral lymphadenopathy were screened and 80 patients with tubercular: lymphadenitis were studied. Their ages ranged from 1 to 65 years; most were younger than 30 years and there was a: slight female preponderance (1.2:1). Seventy per cent of patients were of low socioeconomic status. Of the 80 patients,: 56 had affected cervical nodes, seven had inguinal nodes, five had axillary nodes and 12 had multiple sites of lymph node: involvement. All had enlarged nodes which were matted in 44 cases and discrete in 18 cases, while the rest had either an: abscess or a discharging sinus. Fifty-nine cases (74 per cent) showed a positive Mantoux test and four cases (5 per cent): had associated pulmonary tuberculosis. Fine needle aspiration cytology gave a positive diagnosis in 66 cases (83 per: cent). Fifty-two cases showed a positive culture for Mycobacterium tuberculosis of human type in Lowenstein-Jensen: medium. Short-term chemotherapy (9 months) consisting of rifampicin, isoniazid and ethambutol gave an excellent result.: Surgery was not required in any of the cases.

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Unique Identifier: 90188088

Authors: Lau SK. Wei WI. Hsu C. Engzell UC.

Institution: Department of Surgery, University of Hong Kong, Queen Mary Hospital.

Abstract: The results of a consecutive series of 1,349 fine needle aspiration (FNA) biopsies from the head and neck region of: 1,193 patients has been reviewed in order to evaluate the efficacy of this method in the diagnosis of tuberculous: lymphadenopathy (TBLN). Of the 108 patients whose fine needle aspiration cytology (FNAC) showed granulomatous: changes, 68 had subsequent surgery and histological confirmation of the cytological appearance. Sixty-three had TBLN,: thus the specificity of FNAC was 93 per cent in diagnosing tuberculous related granulomatous lymphadenopathy. One: false positive FNAC was reported histologically to be metastatic mucoepidermal carcinoma. Of the 1,193 patients, 90: patients had subsequently TBLN confirmed histologically. Of these 90 patients, FNA from 69 showed granulomatous: changes or acid fast bacilli (AFB), thus the sensitivity of FNAC in detecting tuberculous lymphadenopathy was 77 per: cent. Fifty-two cytological smears were stained for acid fast bacilli. Nineteen (37 per cent) contained AFB. It is evident: from this review that FNAC is an efficient way to detect cervical tuberculous lymphadenopathy.

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Unique Identifier: 88305467

Authors: Woodring JH. Vandiviere HM. Lee C.

Institution: Department of Diagnostic Radiology, Albert B. Chandler Medical Center, University of Kentucky, Lexington: 40536-0084.

Abstract: In the past, hilar or mediastinal lymphadenopathy was considered by many to be a feature of only the primary or first: infection with Mycobacterium tuberculosis, and to exclude the diagnosis of reactivation or postprimary tuberculosis. In: a series of 56 adult patients with documented postprimary disease due to M tuberculosis, we found hilar or mediastinal: lymphadenopathy in three cases (5%). Although intrathoracic lymphadenopathy was more common in primary: tuberculosis, we do not believe that intrathoracic lymphadenopathy is as specific for primary tuberculosis, particularly: in the adult, as was once thought. For this reason, we believe that the roentgenographic demonstration of intrathoracic: lymphadenopathy should not be used as a definitive research or clinical criterion for primary tuberculosis in an adult.: [References: 11]

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Unique Identifier: 88110711

Authors: Chang SC. Lee PY. Perng RP.

Institution: Department of Chest Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.

Abstract: Twenty-five adult tuberculosis patients with intrathoracic lymphadenopathy were studied. Intrathoracic tuberculous: lymphadenopathy seems rare in Chinese and affects more older and female subjects. The most common symptoms: were cough, followed by chills, fever and the most common physical finding was peripheral lymph node enlargement. The: roentgenographic appearance of mediastinal lesions varied but often included right paratracheal involvement. Nine: patients had clear lungs. Tuberculous involvement was limited to the lower lung field in seven out of 16 patients with: concomitant parenchymal lesions. The remaining nine patients had pulmonary tuberculosis involving the upper lobes.: Consolidation was the most common form of pulmonary lesion. A diagnosis was made on the basis of sputum: examination in nine patients; however, peripheral lymph node examination yielded a higher diagnostic rate (90 percent).: Endobronchial involvement was proved by bronchoscopy in 12 of 16 patients. In three instances, the final diagnosis: could be documented after mediastinoscopy or exploratory thoracotomy.