Incidence of tuberculosis in enlarged neck nodes, our experience

Empirical Antitubercular Treatment for Lymphadenopathy: Are We Missing Lymphoma?

OBJECTIVE

To evaluate the proportion of patients who received empirical treatment with antitubercular therapy (ATT) prior to the diagnosis of Hodgkin lymphoma (HL) in the first multicentric, prospective study on HL from India, and to assess its impact on extent of disease at diagnosis and outcomes.

METHODS

Children < 18 y with biopsy proven HL were enrolled in InPOG-HL-15-01. Along with other clinical and epidemiological data, history of prior treatment with ATT was documented. All patients received treatment as per a risk-stratified, response-adapted strategy.

RESULTS

Out of 396, 115 (29%) children had received ATT prior to establishing a definitive diagnosis of HL. This cohort presented with advanced-stage disease (p = 0.001) and B symptoms (p = 0.001) in a higher proportion of cases. Consequently, those children were more likely to receive 6 rather than 4 cycles of chemotherapy (p = 0.001). They were more likely to have infradiaphragmatic involvement (p = 0.001). Overall survival and event-free survival were not different.

CONCLUSION

Empirical treatment with ATT in children presenting with lymphadenopathy continues to be practiced widely in India. The delay in diagnosis may contribute to children presenting with advanced-stage disease warranting more intensive treatment for successful outcomes.

Review of Head and Neck Masses in the Indian Population Based on Prevalence and Etiology With an Emphasis on Primary Diagnostic Modalities

Head and neck masses are classified as sebaceous cysts (epidermoid cysts), cervical lymphadenopathy, benign lipomas, lymph nodes, thyroid swellings, or tuberculosis lymphadenitis that may be painful or painless, adherent or fluctuant. In spite of this, they have distinct prognoses and pathological features. The anatomical location of the swelling and other demographic manifestations of the patient provide valuable information about the cause and type of swelling. Computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, and ultrasonography are the gold standard imaging methods for the head and neck examination. These methods are used according to the region considered for the study. Fine-needle aspiration cytology of lymph nodes is known to be effective, simple, and sometimes the only tool for the diagnosis of lymph node malignancies. This review highlights the epidemiological aspect of head and neck masses in the Indian population.

FREQUENCY AND DISTRIBUTION OF DIFFERENT TYPES OF CERVICAL LYMPHADENOPATHY IN PATIENTS IN D.I.KHAN DISTRICT, PAKISTAN

Background: Cervical lymphadenopathy is a common medical problem. The objective of the study was to determine the frequency and distribution of different types of cervical lymphadenopathy in patients in D.I.Khan, KP, Pakistan. Material & Methods: This cross sectional study was conducted at Department of ENT, Gomal Medical College, Dera Ismail Khan from April 2013 to March 2016. Sample size was 80, selected through consecutive sampling technique. Patients having enlarged lymph nodes of either sex and of any age of at least 2 months duration were included. Patients having generalized lymphadenopathy were excluded from the study. Gender and age groups were the demographic variables. The research variables were types of cervical lymphadenopathy (tuberculous lymphadenopathy/ reactive hyperplasia/ metastatic carcinoma/ lymphpoma) and side of the neck involved (right/ left). All variables being categorical, the frequencies and percentages were calculated. descriptive statistical analysis was done using SPSS version 10. Results: Out of 80 patients, 42 were males and 38 females. Majority of the patients were in the first decade. Chronic granulomatous diseases especially the tuberculous cervical lymphadenopathy was the most frequent histological findings in 31 patients. Lymphoma was noted in 21, reactive hyperplasia in 18 and metastatic malignancy in 10 cases. Lymph nodes involvement on the right side was more common 36 than on the left side 32. Conclusion: Unilateral tuberculous cervical lymphadenopathy was most common found especially in young males.

Pretracheal tuberculous abcess mimicking a thyroid swelling-A case report

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Tuberculous cervical lymphadenitis is the most common extra pulmonary manifestation (Das et al., 2016 [1], Sharma and Mohan, 2004), posterior group of cervical nodes (Baskota et al., 2004 [2]) being the most common.

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Pre tracheal lymph node involvement in the neck is very rare.

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A high degree of suspicion for tuberculosis is needed while diagnosing a lower midline swelling in the anterior neck, especially in TB- endemic areas.

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Tuberculous abscess can be easily treated with incision and drainage along with anti tuberculous drugs, thus avoiding major surgery.

Introduction

Pretracheal tubercular abscess is a rare presentation of extra pulmonary tuberculosis even in TB- endemic areas (WHO, 2014 [3]). It usually presents in posterior triangle group of lymph nodes (Baskota et al., 2004 [2]).

Presentation of case

We report a case of a lower midline swelling in anterior part of the neck of 6 months duration, with dysphagia of 1 month duration. Radiological diagnosis was established as tuberculous abscess and was drained. Patient was started on anti tuberculous treatment.

Discussion

Swellings anatomically located in the area of anterior group of lymph nodes should be dealt with high degree of suspicion for tubercular etiology especially in TB-endemic areas (WHO, 2014 [3]). Anterior group of lymph node involvement is very rare. To differentiate, proper radiological assessment is needed to differentiate between thyroid nodule and lymph node pathology.

Conclusion

Pre operative assessment is often under estimated. Adequate evaluation will avoid major surgery for a benign pathology like tuberculosis.

Fine needle aspiration cytology for lymph nodes: a three-year study

BACKGROUND AND AIMS

The cytologic patterns of lymph node fine needle aspirations (FNAs) exhibit a wide variation in different diseases and in different ethnic groups in various geographical locations. Knowledge of lymphadenopathy patterns in a given geographical region is essential for making a confident diagnosis of suspected disease in that location. In the present study, we assessed the cytologic patterns of lymph node aspirations in patients in the Huangdao region of China.

METHODS

A three-year retrospective study design was conducted on FNA cytology samples from the lymph nodes of patients in our hospital between January 2011 and December 2014.

RESULTS

A total of 2136 lymph nodes were aspirated during the study period. Cytologic analysis of the lymph nodes revealed the following: malignancy, 53.6%; chronic non-specific lymphadenitis, 15.2%; reactive lymph node, 7.5%; pyogenic abscess, 2.9%; tuberculosis lymphadenitis, 8.7%; Hodgkin lymphoma, 4.8%; and non-Hodgkin lymphoma, 7.16%. The 30-50 year age group was the most affected age group, while lymphadenopathy in the >60 year age group was less frequent. Cervical lymph nodes were the most frequent site for lymphadenopathy in women (31.4%, p < 0.001) and men (49.1%, p < 0.001).

CONCLUSIONS

Lymphadenopathy is associated with a wide range of disorders; however, metastatic lymph nodes of malignancies are the most common cause for enlarged lymph nodes.

Neck masses in paediatric population: An experience with children attended the Central Teaching Hospital of Pediatrics in Baghdad 2008-2009

BACKGROUND

Pediatric neck mass is a frequent cause for surgical consultation. Neck masses can be simply classified into congenital, inflammatory, and neoplastic. Although most of the cases are due to benign processes, malignant causes must not be overlooked. The aim of this study is to assess the paediatric neck masses in Iraqi patients highlighting the distribution of cases according to their demographic characteristics and etiology.

PATIENTS AND METHODS

A cross-sectional observed study is conducted in the Department of Pediatric Surgery, at the Central Teaching Hospital of Pediatrics in Baghdad from April 2008 to March 2009. Sixty four patients with neck masses aged 14 years and below were examined and managed. The underlying causes of the neck masses were addressed and categorized.

RESULTS

Among the 64 patients, 42 (65.6%) were male. The inflammatory group represents 57% of the cases, while the malignant neoplasm accounts for approximately 10% of the conditions mainly due to lymphoma 5 (7.8%). Sixteen patients (25%) fall in the congenital group, in which the thyroglossal duct cyst was the commonest type. Wound infection developed in two patients, while one patient with cystic hygroma showed recurrence.

CONCLUSION

Pediatrics neck masses are distributed in categories that similar in pattern and distribution in the world except the infectious/inflammatory category that shows variation in distribution in respect to the socioeconomic status. The surgical intervention and procedures are related to the facility as well as to the experience.

Cervical Node Tuberculosis in Adults of an Urban Middle Class Community: Incidence and Management

The aim of this study is to estimate the incidence of cervical node tuberculosis (TB) in an urban middle class population and to describe an effective protocol for management of cervical lymphadenopathy. The present study is a prospective observational study conducted over two years (2007-2009) in a community hospital in Mumbai, India. All adults (age ≥14 years) presenting with cervical lymphadenopathy, not resolving were included and their details of history and examination were noted. All patients were subjected to fine needle aspiration cytology (FNAC) and biopsy was done selectively as indicated. The response at 1, 3 and 6 months of starting anti tuberculous treatment (ATT) were noted. A total of 191 patients were included in this study. The mean age was 41 years and male to female ratio was 1:1.1 in patients with cervical lymphadenopathy. A history of contact with a patient of TB was the most significantly associated history seen in patients diagnosed to have TB of cervical nodes (p < 0.001). TB (38.7%) followed by reactive nodes (37.6%) were the most common etiologies. A 90.6% response rate was seen in patients taking 6 months ATT for cervical node TB. The incidence of adult (≥14 years) cervical node TB was 52/100,000 people in an urban middle class community in Mumbai. A single swelling in the neck without other associated symptoms or signs was the commonest mode of presentation of TB of the neck nodes. A history of contact with TB, demonstrated an association with the final diagnosis of tuberculous lymphadenopathy.

Paediatric neck masses at a University teaching hospital in northwestern Tanzania: a prospective analysis of 148 cases

Background

Pediatric neck masses are one of the common surgical conditions presenting to the pediatric surgical wards and clinics in many centers worldwide. There is paucity of published information regarding pediatric neck masses in Tanzania and the study area in particular. This study determines the etiology, clinico-histopathological patterns and treatment outcome of pediatric neck masses and to identify predictors of outcome in our local setting.

Methods

This was a prospective cross-sectional hospital based study done in children aged ten years and below with neck masses for a five months period. Statistical data analysis was done using SPSS version 17.0.

Results

A total of 148 patients were studied. Their ages ranged from 2 months to 10 years (median 3 years). The male to female ratio was 2.5:1. Inflammatory lesions were the most frequent cause of neck masses accounting for 43.9% of cases. The median duration of illness was 2 years. Except for the neck mass, 72 (48.6%) of the children had clinically stable health condition on presentation. The posterior triangle was commonly involved in 118 (79.7%) patients. eight (5.4%) were HIV positive. The majority of patients (95.9%) were treated surgically. Postoperative complication rate was 30.4% and surgical site infection was the most frequent complication in 37.5% of cases. The median length of hospital stay was 10 days and was significantly longer in patients with malignant masses and those with surgical site infection (p <0.001). The overall mortality rate in this study was 8.1% and it was significantly associated with malignant masses, associated pre-existing illness, late presentation, HIV positivity, low CD 4 count, high ASA class and presence of surgical site infections (p <0.001). The outcome of patients on discharge was excellent as more than 90% of patients were successfully treated and discharged well.

Conclusion

Pediatric neck masses are among the most common causes of paediatric surgical admissions and pose a diagnostic and therapeutic challenge in our setting. We advocate early surgical consultation and thorough and timely histopathological examination of neck masses in children.

[Histopathological study of cervical lymphadenopathy in Yaounde, Cameroon]

Introduction

Les adénopathies cervicales ont été très peu étudiées au Cameroun.

Méthodes

Pour améliorer leur connaissance nous avons mené une étude rétrospective et descriptive dans les cinq principaux laboratoires de la capitale du pays en vue d'en déterminer les aspects histopathologiques.

Résultats

Nous avons colligé 292 cas. L’âge moyen était de 30,95 ±4,11ans et le ratio homme / femme était de 0,96/1. Les principaux diagnostics histologiques étaient les suivants: tuberculose ganglionnaire (39,38%), les lymphadénites (18,49%), les lymphomes malins non hodgkiniens (12,33%), la maladie de Kaposi ganglionnaire (5,82%), les métastases de carcinome (5,82%) et la maladie de Hodgkin (5,14%). Dans 95,65% des cas le diagnostic était posé au-delà du deuxième mois d’évolution des symptômes.

Conclusion

Nos résultats, quoique préliminaires, sont une contribution à l'amélioration de la stratégie diagnostique et thérapeutique dans nos hôpitaux aux ressources limitées.