Critical appraisal of fine needle aspiration cytology in tuberculous lymphadenitis.

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.     

Acid-fast bacilli in aspiration smears from tuberculous lymph nodes. An analysis of 255 cases

An analysis of fine needle aspiration (FNA) smears from 255 patients with tuberculous lymphadenopathy was done. The aspirates were either purulent, cheesy or mixed with blood. A total of 56.4% of all cases aspirated showed acid-fast bacilli. Of the cases in which purulent material was aspirated, 66% were positive for acid-fast bacilli. These findings stress the importance of doing Ziehl-Neelsen staining in smears of all cases suspected of being tuberculous in etiology, particularly when purulent material is aspirated.     

Dermatopathic Lymphadenopathy—A Clinicopathologic Analysis of Lymph Node Biopsy Over a 15-Year Period

Forty cases of dermatopathic lymphadenopathy were found in a series of 906 consecutive lymph node biopsies (4.8 per cent).The histologic development and progression of the disease was correlated with the clinical state of the patient.In 35 of 40 cases the patients had active skin disease at the time of the biopsy; one of the remaining five patients had Hodgkin''s disease, one had multiple myeloma and one had secondary syphilis. In the other two, no organic cause was found.In nine cases (22.5 per cent), the histological pattern typical of dermatopathic lymphadenopathy was associated with malignant lymphoma. Except for two biopsies, which showed coexisting malignant lymphoma and dermatopathic lymphadenopathy, no histologic features were found which distinguished patients with malignant lymphoma from the remainder.While the pathogenesis of the lymph node changes remains obscure, the histologic features suggest that it is at least in part an immune response, although the nature of the responsible antigen is unknown.     

Persistent generalized lymphadenopathy in homosexual men: clinical,pathological and immunologic characteristics.

Eighteen homosexual men who had had lymphadenopathy in two or more extrainguinal sites for more than 5 months but had no evidence of other illnesses or infections were studied. All had extreme malaise, and 90% had additional symptoms (fever, night sweats, weight loss or gastrointestinal dysfunction). They were compared with 10 healthy homosexual and 10 healthy heterosexual male controls. The mean numbers of circulating T8 (suppressor) lymphocytes were increased equally in the two homosexual groups, but the mean number of T4 (helper) lymphocytes was decreased only in the group with lymphadenopathy. The response to testing for recall anergy was diminished in both homosexual groups but was significantly lower in the group with lymphadenopathy. The serum immunoglobulin and complement concentrations and the numbers of circulating B lymphocytes were normal in each group. Seven of nine lymph node biopsy specimens showed characteristic hyperplasia and confluence of follicles. Thus, idiopathic persistent, generalized lymphadenopathy in homosexual men without opportunistic infections or malignant diseases appears to be a distinct syndrome; it may also be related to the acquired immune deficiency syndrome.     

Fine needle aspiration cytology diagnosis of tuberculous thyroiditis. A report of eight cases.

Among 1,283 cases of thyroid lesions subjected to fine needle aspiration cytology (FNAC) over a period of two years, 8 cases (0.6%) were found to be having cytologic features consistent with tuberculous thyroiditis. The ages of the patients ranged from 14 to 65 years, with a median of 30. The male:female ratio was 4:4. Six cases clinically presented with solitary nodules of the thyroid and two cases as abscesses in the thyroid region. Three patients had concomitant cervical lymphadenopathy, and only two patients were known cases of tuberculosis on treatment. Ultrasonography, done in seven cases, confirmed solitary nodules in four; in one case the differentiation between an extrathyroid nodule and cystic isthmic nodule was difficult, and in the remaining two cases the lesions were found to be extrathyroid. Fine needle aspirates from thyroid swellings showed epithelioid granuloma with necrosis in five cases and necrosis without epithelioid granuloma in three cases. The number of cases positive for acid-fast bacilli in these two groups were two and three, respectively. Lymph node aspiration, done in three cases, revealed necrotic material in two; both were positive for acid-fast bacilli, and the third case showed epithelioid granuloma without necrosis.     

Spectrum of cytomorphology of tuberculous lymphadenitis and changes during anti-tubercular treatment

OBJECTIVE: To analyse the morphological changes in tuberculous lymph nodes and the clinical response during short course anti tubercular chemotherapy. METHODS: Thirty-six patients with tuberculous lymphadenitis under treatment were followed up clinically and cytologically at 0, 2, 4 and 6 months. RESULTS: Twenty-six (72.2%) patients had palpable lymph nodes at the end of chemotherapy. Of the 14 patients with residual lymph nodes exceeding 1 cm in size, 92.8% (13) still had evidence of continuation of the disease. Acid-fast bacilli could be found in 38.8% patients at the end of 6 months. Intense lymphocytic infiltration of granulomata in the early phase of chemotherapy predicted a favourable outcome. CONCLUSIONS: Following completion of anti-tubercular treatment a significant percentage of patients have persistent lymphadenopathy and harbour the disease. Morphological follow up of these patients is essential as they may be at increased risk of relapse.     

Abrasive bronchial brushing cytology. A preliminary study of 200 specimens for the diagnosis of neoplastic and nonneoplastic bronchopulmonary lesions

Two hundred subjects with chronic respiratory symptoms with a suspicion of malignancy were selected for bronchial brushing cytology. Prior sputum examination had shown malignant squamous cells in two cases only. The cytologic appearances of the brushing smears were divided into five categories: 41 (20.5%) smears with positively malignant cells; 20 (10%) smears predominantly showing chronic inflammatory features; 31 (15.5%) smears with mainly acute inflammatory changes; 60 (30%) smears with normal cytologic features; and 48 (24%) smears unsatisfactory for cytologic interpretation. Thirteen patients with a positive cytology had a positive tissue biopsy for malignancy. Among the group with chronic inflammatory changes, acid-fast bacilli were identified in nine cases, and one smear showed frank tuberculous granuloma. In the unsatisfactory group, two cases showed malignant cells in the postbrushing sputum. There was one false-negative report for malignancy in the entire study. This study confirms the sensitivity and accuracy of bronchial brushing cytology in the diagnosis of various bronchopulmonary lesions, especially malignancy and pulmonary tuberculosis, in India.     

Acid-fast bacilli in fine needle aspiration smears from tuberculous lymph nodes. Where to look for them

OBJECTIVE: To analyze where acid-fast bacilli (AFB) are most often seen in smears prepared from tuberculous lymph nodes. STUDY DESIGN: Patients referred for fine needle aspiration cytology for evaluation of lymphadenopathy between March 1994 and June 1998 were analyzed. Only those cases clinically and therapeutically proven to be tuberculous were included in the study. RESULTS: Of 783 cases analyzed, 213 (27.2%) were tuberculous. Aspirates obtained were of three types: blood-mixed particles, caseous material and pus. Five cytologic pictures were seen: epithelioid cell granulomas alone or with coexistent necrosis, AFB or both, and necrosis with AFB. AFB were most often seen in purulent aspirates, followed by caseous and least often in blood-mixed particles. Granulomas were most often seen when the aspirate was blood-mixed particles, followed by caseous and, least often, pus. CONCLUSION: AFB detection should be carried out on all suspected tuberculous patients. The relationship between the presence of granuloma and of AFB is inverse. The chance of finding AFB is highest in patients presenting with a cold abscess and yielding pus on aspiration followed by patients who yield caseous material on aspiration.     

Fine needle aspiration cytology in systemic lupus erythematosus lymphadenopathy. A case report

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology characterized by inflammation in various organ systems, including lymph nodes, due to the production of antinuclear antibodies. The onset of disease is between ages 13 and 40 years, with a female preponderance. CASE: A 30-year-old female presented with right cervical lymphadenopathy and gave a history of intermittent fever and swollen joints of 2.5 years' duration. The patient was on intermittent corticosteroids. With a suggestion of tuberculous lymphadenitis, the patient underwent fine needle aspiration (FNA). The diagnosis of lupus adenopathy was established by FNA of enlarged right cervical lymph nodes. Smears showed predominantly typical and atypical immunoblasts, plasma cells, occasional Reed-Sternberg-like cells and dispersed hematoxylin bodies. Smears were negative for acid-fast bacilli. CONCLUSION: When SLE patients develop lymphadenopathy, FNA cytology helps differentiate lupus adenopathy from infectious conditions, such as tuberculous adenitis, and from Kikuchi's lymphadenitis.     

Colloid carcinoma of the breast with concomitant metastasis and a tuberculous lesion in the axillary lymph nodes. A case report.

A 30-year-old woman presented with a lump in the left breast and left axillary lymphadenopathy that, on fine needle aspiration cytology (FNAC), proved to be duct cell carcinoma with metastasis. Histology of the radical mastectomy specimen showed a mixed colloid carcinoma. Axillary lymph nodes revealed a variety of pathologic changes consisting of reactive hyperplasia, tuberculosis and metastasis. A combination of a tuberculous lesion and metastasis in the same lymph nodes was also found. During follow-up, after radiotherapy, the patient developed left supraclavicular and right cervical lymphadenopathy that, on FNAC, revealed a tuberculous lesion and metastasis, respectively. The rarity of this condition with double pathology is highlighted, and the reason behind the limitations of FNA in subtyping the primary malignancy and its failure to detect the tuberculous lesion in the axillary lymph node are discussed.     

腺苷脱氨酶在结核性胸膜炎和恶性胸腔积液的对比临床分析

目的：探究腺苷脱氨酶在结核性胸腔积液和恶性胸腔积液中的含量规律。方法：回顾分析自2010年3月至2012年5月于本院胸心外科住院的胸腔积液患者,对穿刺获得的胸腔积液,用比色法测定胸腔积液中腺苷脱氨酶的水平。测量血中腺苷脱氨酶的水平进行对比。结果：结核性胸膜炎组患者胸腔积液ADA测定值为89．67±47．85IU／L,癌性胸腔积液组水平为24．56±11．491U／L,胸腔积液ADA水平在结核性胸膜炎与癌性胸腔积液组之间存在显著性差异（P〈0．05）;以ADA〉45IU／L诊断结核性胸膜炎：则敏感性为（48／51）94．1,特异性为（48／52）88．9％,以ADA〈45IU／L一诊断恶性胸腔积水：则敏感性（（51／55）89．4％,特异性为（51／54）94．4％;结核性胸膜炎中胸腔积液ADA／血清中ADA比值为2．25±0．72,癌性胸腔积液组水平0．43＋0．1,结核性胸膜炎与癌性胸腔积液组之间存在显著性差异（P〈0．05）;以胸腔积液ADA／血清中ADA比值〉1．0为界诊断结核性胸膜炎：则敏感性为（46／51）90．1,特异性为（45／55）81．8．％,以胸腔积液ADA／血清中ADA比值〈1．0诊断恶性胸腔积水：则敏感性（47／57）82．4％,特异性为（47／53）88．7％。结论：腺苷脱氨酶在结核性胸膜炎和恶性胸腔积液中的含量有明显差异。     

Cell origins and diagnostic accuracy of interleukin 27 in pleural effusions

The objective of the present study was to investigate the presence of interleukin (IL)-27 in pleural effusions and to evaluate the diagnostic significance of pleural IL-27. The concentrations of IL-27 were determined in pleural fluids and sera from 68 patients with tuberculous pleural effusion, 63 malignant pleural effusion, 22 infectious pleural effusion, and 21 transudative pleural effusion. Flow cytometry was used to identify which pleural cell types expressed IL-27. It was found that the concentrations of pleural IL-27 in tuberculous group were significantly higher than those in malignant, infectious, and transudative groups, respectively. Pleural CD4(+) T cells, CD8(+) T cells, NK cells, NKT cells, B cells, monocytes, macrophages, and mesothelial cells might be the cell sources for IL-27. IL-27 levels could be used for diagnostic purpose for tuberculous pleural effusion, with the cut off value of 1,007 ng/L, IL-27 had a sensitivity of 92.7% and specificity of 99.1% for differential diagnosing tuberculous pleural effusion from non-tuberculous pleural effusions. Therefore, compared to non-tuberculous pleural effusions, IL-27 appeared to be increased in tuberculous pleural effusion. IL-27 in pleural fluid is a sensitive and specific biomarker for the differential diagnosing tuberculous pleural effusion from pleural effusions with the other causes.     

细胞因子IFN-γ,IL-2,TNF-α和ADA对结核性和恶性胸腔积液鉴别诊断的价值

目的：探讨细胞因子γ-干扰素（IFN-γ）、白介素-2（IL-2）、肿瘤坏死因子-α（TNF-α）和腺苷脱氨酶（ADA）对结核性和恶性胸腔积液的鉴别诊断的价值。方法：以2012年9月至2013年3月期间在青岛大学医学院附属医院呼吸科及青岛胸科医院未经治疗的胸腔积液患者为研究对象,其中恶性胸腔积液患者46例,结核性胸腔积液患者42例。采用双抗体夹心酶联免疫吸附测定法（ELISA）分别检测结核性和恶性胸腔积液患者中IFN-γ、IL-2、TNF-α及ADA的表达情况。并应用ROC曲线分析两组患者胸腔积液中IFN-γ、IL-2、TNF-α及ADA的表达差异及意义。结果：结核性胸腔积液组IFN-γ、IL-2、TNF-α及ADA的表达明显高于恶性胸腔积液组,差异有统计学意义（t=8.118、8.126、8.066、7.221;P=0.000、0.000、0.000、0.000,P〈0.001）;ROC曲线分析结果显示胸腔积液中IFN-γ、IL-2、TNF-α及ADA的诊断临界值为201.45 pg/mL、41.91 pg/mL、21.55 pg/mL、33.78 U/L;诊断敏感度分别为91.3%、93.5%、91.2%、89.1%;特异度分别为91.0%、92.1%、89.9%、90.1%。结论：胸腔积液中IFN-γ、IL-2、TNF-α及ADA的表达对结核性和恶性胸腔积液诊断与鉴别诊断具有重要参考价值。     

Opportunistic infections and acquired cellular immune deficiency among Haitian immigrants in Montreal.

Eight Haitian immigrants (five with acquired immune deficiency syndrome [AIDS] and three with the signs and symptoms of AIDS but without opportunistic infections or malignant diseases) are described. All had malaise, weight loss, fever and generalized lymphadenopathy. All five of those with opportunistic infections died from the infections, which were multiple in four cases. Septic shock due to Escherichia coli or Klebsiella pneumoniae developed in two patients. Evidence of immune deficiency in the AIDS patients included anergy, lymphocytopenia (in all but two), polyclonal hypergamma-globulinemia and abnormal sizes of the subsets of circulating T lymphocytes. Autopsies revealed no recognizable causes for immune deficiency; the lymph nodes showed follicular hyperplasia in four cases and lymphocyte depletion in one case. Except for the absence of opportunistic infections, the illness in the three patients not classed as having AIDS was indistinguishable from that in the other five, which suggests that this syndrome is AIDS-related, like the persistent generalized lymphadenopathy that occurs in homosexual men and patients with hemophilia.     

血清和胸水中CA125在结核性和癌性胸水中的表达及临床意义

目的:探讨血清和胸水中CA125在结核性和癌性胸水中的表达及鉴别诊断意义。方法:抽选我院确诊的结核性胸水病人85例(结核组)和癌性胸水病人71例(癌症组),检测两组患者血清和胸水中CA125表达,并以胸水/血清中CA125比值10(p-CA125/s-CA12510)为临界值,观察其对癌性胸水的鉴别特异度、灵敏度及准确性。结果:癌症组胸水中CA125表达及p-CA125/s-CA125比值均显著高于结核组(P0.05);但血清中两组CA125表达比较差异无显著性(P0.05);两组胸水中,以35U/ml为临界值,两组患者阳性率92.9%(79/85)、100%(71/71)比较差异无显著性(X2=7.0718,P=0.0078)。癌症组中p-CA125/sCA125比值10的比率(84.5%VS 17.6%)明显高于结核组(X2=66.6244,P=0.0000);并以其为诊断癌性胸水的临界值,鉴别诊断特异度、灵敏度及准确性分别为82.3%、84.5%、83.3%。结论:血清和胸水中CA125表达对于鉴别结核性或者是癌性胸水的临床意义不大,但是p-CA125/s-CA125比值对于鉴别结核性和癌性胸水具有一定临床价值。     

Detection of serum antibodies to Bartonella henselae and Coxiella burnetii from Japanese children and pregnant women

The participation of Bartonella henselae and Coxiella burnetii in the pathogenesis of fever of unknown origin (FUO) and lymphadenopathy has not been completely clarified. Prevalence of these two agents in Japanese children is also unknown. Serum IgG and IgM antibodies to B. henselae and to C. burnetii were examined by the indirect fluorescence antibody assay. Enzyme immunoassay kits were used to detect serum IgG and IgA antibodies against Chlamydia trachomatis. Out of 200 healthy normal pregnant women, two (1.0%) had serum IgG antibodies to B. henselae, four (2.0%) to C. burnetii and 49 (24.5%) to C. trachomatis. Out of 29 patients with FUO, one (3.4%) had serum IgG antibodies to B. henselae, four (13.8%) to C. burnetii and none to C. trachomatis. Out of 31 patients with cervical lymphadenopathy, three (9.6%) had serum IgG antibodies to B. henselae, two (6.5%) to C. burnetii and none to C. trachomatis. Out of 22 patients with generalized lymphadenopathy, one (4.5%) had serum IgG antibodies to B. henselae, three (13.6%) to C. burnetii and none to C. trachomatis. Prevalences of serum antibodies to C. burnetii in the patients with FUO and generalized lymphadenopathy and to B. henselae in the patients with cervical lymphadenopathy were significantly higher than those of normal pregnant women (Welch's t-test; P<0.01). These two agents may have some roles in the pathogenesis of FUO and lymphadenopathy in Japanese children.     

The Vancouver Lymphadenopathy-AIDS Study: 1. Persistent generalized lymphadenopathy

The Vancouver Lymphadenopathy-AIDS (acquired immune deficiency syndrome) Study is an ongoing prospective study of over 700 homosexual men attending six primary care practices in central Vancouver. A case-control study of risk factors for persistent generalized lymphadenopathy in homosexual men was conducted in five of the practices. The participants completed a questionnaire and underwent a complete physical examination at the time of enrolment and at a subsequent visit not less than 3 months later, and laboratory tests were performed after both visits. Persistent generalized lymphadenopathy was defined as the presence of lymph nodes greater than 1 cm in diameter at two or more extrainguinal sites for more than 3 months. Of the 519 patients who had completed both visits by February 1984, 126 (24%) were found to have the disease, and two controls without lymphadenopathy were frequencymatched on the basis of age and practice to each subject. More than 100 male sexual partners during one''s lifetime, frequent receptive anal intercourse, a history of gonorrhea, use of illicit drugs and sexual contact in Los Angeles were identified as independent risk factors for persistent generalized lymphadenopathy. The similarity of these risk factors to those established for AIDS supports the hypothesis of a common etiology for the two diseases, and the high prevalence rate of persistent generalized lymphadenopathy further supports the hypothesis that AIDS is an uncommon response to a relatively common agent.     

Early recognition of cardiac tamponade.

Nine patients with cardiac tamponade were seen in an 11-month period. Analysis of the clinical and laboratory data indicated that pulsus paradoxus was the most useful physical sign and echocardiography the most useful investigative technique. Three of nine patients died but in only one was the late recognition of tamponade a possible factor in the outcome. Pericardial fenestrations were required in four patients. Viral pericarditis accounted for the tamponade in three cases. There were two cases each of uremia and malignant disease and one case of tuberculous pericarditis. One other case followed pericardiectomy. In five patients tamponade was the initial manifestation of illness.     

Lymphadenopathy and selective IgA deficiency.

Four men presented with unexplained lymphadenopathy. Three had a history of recurrent respiratory infections for several years, and two had lymph node or hepatic granulomas. None was noted to have symptoms of immunodeficiency at the time of presentation. In one patient routine direct immunofluorescence study failed to detect IgA, and immunological investigations were therefore conducted in the rest. In all patients the findings were similar and characterised by a severe deficiency of IgA. In the absence of a more serious cause selective IgA deficiency may be enough to explain "idiopathic" lymphadenopathy.     

Diagnostic value of ferritin in the differential diagnosis of malignant effusions

The diagnostic value of ferritin in pleural effusions or ascites was studied in 151 samples from 147 patients (four patients had both kind of effusions). Samples (99 pleural effusions, 52 ascites) were evaluated in 4 groups: benign transudate (27 cases), benign nontuberculous exudate (26 cases), tuberculous exudate (47 cases) and malignant exudate (51 cases). Median ferritin levels in effusions were 67 ng/ml, 805 ng/ml, 889 ng/ml, 998 ng/ml and median effusion/serum (E/S) ratios were 0.7. 2.0, 4.9, 3.2 respectively. There was a significant difference between the concentrations of ferritin in malignant (51 cases) and nonmalignant effusions (100 cases) (p < 0.001), but the specificity and positive predictive value were low (43% and 45% respectively). Ferritin levels in transudate group were significantly lower than those in the others (p < 0.001). However, ferritin concentrations in three exudate groups were similar (p > 0.05). When compared the all inflammatory effusions (malignant, tuberculous, nontuberculous inflammatory exudates) with noninflammatory effusions (transudate and exudate), we determined a significant difference (p < 0.001). CONCLUSIONS: 1) Elevated ferritin concentration in effusions is significant indicators of exudates; 2) It is not good a parameter to discriminate the malignant effusions from the benign ones; 3) They can be useful in the differential diagnosis of the inflammatory exudations from the noninflammatory ones.