Bartonella species are bacterial pathogens responsible for Cat Scratch Disease (CSD) with various clinical manifestations, ranging from self-limiting febrile illnesses to severe systemic infections. Diagnosis is often...Bartonella species are bacterial pathogens responsible for Cat Scratch Disease (CSD) with various clinical manifestations, ranging from self-limiting febrile illnesses to severe systemic infections. Diagnosis is often challenging due to its insidious nature and variable presentation based on the body’s immune status. Such a scenario emerged when a 25-year-old male presented to our hospital with nonspecific symptoms of Fever of unknown origin that were not responding to antibiotics until a timely diagnosis of Bartonella infection. This case report highlights the importance of considering Bartonella as a potential etiology in patients with prolonged Fever of unknown origin, especially in endemic regions.展开更多
AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate fo...AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.展开更多
We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University...We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.展开更多
This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever.Due to ambiguous clinical findings,which were suggestive of either a...This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever.Due to ambiguous clinical findings,which were suggestive of either abdominal tuberculosis,or a lymphoma,the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region.The blood culture reports,however,were reported to grow colonies of Salmonella paratyphi A;thus the diagnosis of the patient was changed to enteric fever,and the patient improved on the subsequently started therapy of ceftriaxone 2000 mg bid.To the best of our knowledge,this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.展开更多
Objective To explore the features of various mediastinal lymphadenopathies using computed tomography perfusion(CTP).Methods CTP parameters(CTPs) of the selected mediastinal nodes from 59 patients with pathology-proven...Objective To explore the features of various mediastinal lymphadenopathies using computed tomography perfusion(CTP).Methods CTP parameters(CTPs) of the selected mediastinal nodes from 59 patients with pathology-proven malignant lymph nodes and of those from 29 patients with clinically diagnosed or pathology-proven inflammatory lymphadenopathies were collected.Patients were divided into subgroups by etiology and phase of primary disease,including different pathological malignant nodes and diverse inflammatory nodes.CTPs were defined as blood flow(BF),blood volume(BV),mean transit time(MTT),permeability(PMB),and time to peak(TTP).Differences of CTPs were compared between malignant and benign nodes,and among subgroups,respectively.Results In the mediastinum,no significant differences of CTPs were found between malignant and benign groups(all P>0.05),the same for subgroups of malignant nodes(all P>0.05).Acute lymphadenitis had higher BF and BV than chronic inflammatory,lymphoid tuberculosis,sarcoidosis and malignant nodes.The BF of malignant nodes was markedly slower than that of acute lymphadenitis(P=0.01),but faster than chronic inflammatory nodes(P=0.04) and sarcoidosis(P=0.03),with no significant difference compared with lymphoid tuberculosis.Pneumonia-complicated lymphoid tuberculosis showed the longest MTT while sarcoidosis displayed the shortest MTT,and inflammatory nodes,lymphoid tuberculosis without complicated pneumonia and malignant nodes had moderate MTT.Conclusion CTPs show promising potential in distinguishing various lymphadenopathies in the mediastinum,but more studies are needed to improve their specificity.展开更多
Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the a...Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.展开更多
Objective:To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer,tuberculosis and sarcodosis,and to explore its sensitivity and spec...Objective:To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer,tuberculosis and sarcodosis,and to explore its sensitivity and specificity.Methods:Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1,2012 and June 30,2015 for were retrospectively analyzed.The sensitivity,specificity,positive predictive value,and negative predicted value [including 95% confidence interval (CI)] were calculated..Results:A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred.EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI:81%-92%),a specificity of 100.0% (124/124) (95% CI:97%-100%),and a negative predicted value of 41.3% (95% CI:23%-61%) in the detection of lung cancer.The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI:53%-87%) and 100.0% (95% CI:82%-100%);while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI:29%-96%) and 100.0% (95% CI:91%-100%).Conclusions:The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.展开更多
The histopathology, immunophenotype and clinical presentations of 24 cases of immunoblastic lymphadenopathy(IBL)-like T-cell lymphoma were studied. The results showed that fever and generalized lymphadenopathy were th...The histopathology, immunophenotype and clinical presentations of 24 cases of immunoblastic lymphadenopathy(IBL)-like T-cell lymphoma were studied. The results showed that fever and generalized lymphadenopathy were the first appeared and more commonly occurred clinical manifestations. 12 of 19 cases(63. 2%) which had been followed up died of relapse and progression of the disease.Pathologically, focus and/ or sheet- like proliferation of tumorous lymphoid cells, including pale cells and convoluted cells with obliteration of involved lymph nodes was the histologic feature of the disease. Within these 24 cases of IBL-like T-cell lymphomas diagnosed by morphologic criteria, tumor cells of 20 cases gave positive reaction to T-cellmarkers and the remaining 4 cases were reactive to B cell markers as well. Immunoblasts and plasma cells showed polyclonal proliferation. Immunotypic analysis showed that rearrangement of T-cell receptor beta chain was detected in 1 case of the disease. Pathologic diagnosis of the disease and relationships between biologic behaviors and the prognosis were also discussed.展开更多
Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy ...Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.展开更多
AIM:To compare a first diagnostic procedure of transbronchial needle aspiration(TBNA)with selection of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)or TBNA for mediastinal lymphadenopathy.METHODS:Sixty-...AIM:To compare a first diagnostic procedure of transbronchial needle aspiration(TBNA)with selection of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)or TBNA for mediastinal lymphadenopathy.METHODS:Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography(CT),who required cytopathological diagnosis,were recruited.The first 34 underwent a sequential approach in which TBNA was performed first,followed by EUS-FNA if TBNA was unrevealing.The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.RESULTS:The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%.In the selective approach,the diagnostic yield of the first procedure was 71%.There was no significant difference in the overall diagnostic yield,but there were significantly fewer combined procedures with the selective approach.CONCLUSION:Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.展开更多
BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51...BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51-year-old female was referred to our hospital with epigastric pain.Computed tomography showed a solitary liver mass combined with the enlargement of multiple mediastinal and cervical lymph nodes,clinically mimicking a liver carcinoma with extensive lymph node metastasis.However,core needle biopsy suggested BAF with malignant transformation.Finally,the patient underwent curative resection of the neoplasm and was recurrence-free for 12 mo.CONCLUSION Our case serves as an example of a rare manifestation of BAF.Our report and the previously published experience,reinforce that curative resection should be considered the primary treatment for BAFs with malignant transformation,leading to a favorable prognosis.展开更多
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.AIM To evaluate the ...BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.AIM To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.METHODS This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy.The specimens were defined as positive for malignancy,negative for non-malignancy(tuberculosis,sarcoidosis,etc.),and without a definitive diagnosis.Sensitivity,negative predictive value(NPV)for malignancy,and overall accuracy were calculated.Complications were recorded.RESULTS A total of 80 patients underwent EBUS-TBNA and had a final diagnosis,among which 50(62.5%)were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis,14(17.5%)were diagnosed with primary lung cancer with nodal involvement,and 16(20.0%)exhibited benign behavior including tuberculosis,sarcoidosis and reactive lymphadenitis or who had benign follow-up.The diagnostic sensitivity,NPV,and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8%(n=60/64),80.0%(n=16/20),and 95.0%(n=76/80),respectively.In the multivariate analysis,longer short axis of the lymph node(OR:1.200,95%CI:1.024-1.407;P=0.024)and synchronous lung lesion(OR:19.449,95%CI:1.875-201.753;P=0.013)were independently associated with malignant intrathoracic lymphadenopathy.No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy,and no major complication was observed.CONCLUSION EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.展开更多
文摘Bartonella species are bacterial pathogens responsible for Cat Scratch Disease (CSD) with various clinical manifestations, ranging from self-limiting febrile illnesses to severe systemic infections. Diagnosis is often challenging due to its insidious nature and variable presentation based on the body’s immune status. Such a scenario emerged when a 25-year-old male presented to our hospital with nonspecific symptoms of Fever of unknown origin that were not responding to antibiotics until a timely diagnosis of Bartonella infection. This case report highlights the importance of considering Bartonella as a potential etiology in patients with prolonged Fever of unknown origin, especially in endemic regions.
文摘AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.
文摘We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.
文摘This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever.Due to ambiguous clinical findings,which were suggestive of either abdominal tuberculosis,or a lymphoma,the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region.The blood culture reports,however,were reported to grow colonies of Salmonella paratyphi A;thus the diagnosis of the patient was changed to enteric fever,and the patient improved on the subsequently started therapy of ceftriaxone 2000 mg bid.To the best of our knowledge,this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.
文摘Objective To explore the features of various mediastinal lymphadenopathies using computed tomography perfusion(CTP).Methods CTP parameters(CTPs) of the selected mediastinal nodes from 59 patients with pathology-proven malignant lymph nodes and of those from 29 patients with clinically diagnosed or pathology-proven inflammatory lymphadenopathies were collected.Patients were divided into subgroups by etiology and phase of primary disease,including different pathological malignant nodes and diverse inflammatory nodes.CTPs were defined as blood flow(BF),blood volume(BV),mean transit time(MTT),permeability(PMB),and time to peak(TTP).Differences of CTPs were compared between malignant and benign nodes,and among subgroups,respectively.Results In the mediastinum,no significant differences of CTPs were found between malignant and benign groups(all P>0.05),the same for subgroups of malignant nodes(all P>0.05).Acute lymphadenitis had higher BF and BV than chronic inflammatory,lymphoid tuberculosis,sarcoidosis and malignant nodes.The BF of malignant nodes was markedly slower than that of acute lymphadenitis(P=0.01),but faster than chronic inflammatory nodes(P=0.04) and sarcoidosis(P=0.03),with no significant difference compared with lymphoid tuberculosis.Pneumonia-complicated lymphoid tuberculosis showed the longest MTT while sarcoidosis displayed the shortest MTT,and inflammatory nodes,lymphoid tuberculosis without complicated pneumonia and malignant nodes had moderate MTT.Conclusion CTPs show promising potential in distinguishing various lymphadenopathies in the mediastinum,but more studies are needed to improve their specificity.
文摘Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.
基金grants from the National Science Foundation of China(NSFC)(No.81260010,81460006).
文摘Objective:To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer,tuberculosis and sarcodosis,and to explore its sensitivity and specificity.Methods:Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1,2012 and June 30,2015 for were retrospectively analyzed.The sensitivity,specificity,positive predictive value,and negative predicted value [including 95% confidence interval (CI)] were calculated..Results:A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred.EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI:81%-92%),a specificity of 100.0% (124/124) (95% CI:97%-100%),and a negative predicted value of 41.3% (95% CI:23%-61%) in the detection of lung cancer.The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI:53%-87%) and 100.0% (95% CI:82%-100%);while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI:29%-96%) and 100.0% (95% CI:91%-100%).Conclusions:The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.
文摘The histopathology, immunophenotype and clinical presentations of 24 cases of immunoblastic lymphadenopathy(IBL)-like T-cell lymphoma were studied. The results showed that fever and generalized lymphadenopathy were the first appeared and more commonly occurred clinical manifestations. 12 of 19 cases(63. 2%) which had been followed up died of relapse and progression of the disease.Pathologically, focus and/ or sheet- like proliferation of tumorous lymphoid cells, including pale cells and convoluted cells with obliteration of involved lymph nodes was the histologic feature of the disease. Within these 24 cases of IBL-like T-cell lymphomas diagnosed by morphologic criteria, tumor cells of 20 cases gave positive reaction to T-cellmarkers and the remaining 4 cases were reactive to B cell markers as well. Immunoblasts and plasma cells showed polyclonal proliferation. Immunotypic analysis showed that rearrangement of T-cell receptor beta chain was detected in 1 case of the disease. Pathologic diagnosis of the disease and relationships between biologic behaviors and the prognosis were also discussed.
文摘Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.
文摘AIM:To compare a first diagnostic procedure of transbronchial needle aspiration(TBNA)with selection of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)or TBNA for mediastinal lymphadenopathy.METHODS:Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography(CT),who required cytopathological diagnosis,were recruited.The first 34 underwent a sequential approach in which TBNA was performed first,followed by EUS-FNA if TBNA was unrevealing.The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.RESULTS:The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%.In the selective approach,the diagnostic yield of the first procedure was 71%.There was no significant difference in the overall diagnostic yield,but there were significantly fewer combined procedures with the selective approach.CONCLUSION:Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.
基金Supported by Innovative Project of Medical and Health Science,Zhejiang Province,No.2021RC002。
文摘BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51-year-old female was referred to our hospital with epigastric pain.Computed tomography showed a solitary liver mass combined with the enlargement of multiple mediastinal and cervical lymph nodes,clinically mimicking a liver carcinoma with extensive lymph node metastasis.However,core needle biopsy suggested BAF with malignant transformation.Finally,the patient underwent curative resection of the neoplasm and was recurrence-free for 12 mo.CONCLUSION Our case serves as an example of a rare manifestation of BAF.Our report and the previously published experience,reinforce that curative resection should be considered the primary treatment for BAFs with malignant transformation,leading to a favorable prognosis.
基金Supported by The Wu Jieping Medical Foundation Special Fund for Clinical Research,No.320.6750.2021-04-71Open Research Fund of NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases,No.KF202101Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences,No.2020-PT330-003。
文摘BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.AIM To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.METHODS This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy.The specimens were defined as positive for malignancy,negative for non-malignancy(tuberculosis,sarcoidosis,etc.),and without a definitive diagnosis.Sensitivity,negative predictive value(NPV)for malignancy,and overall accuracy were calculated.Complications were recorded.RESULTS A total of 80 patients underwent EBUS-TBNA and had a final diagnosis,among which 50(62.5%)were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis,14(17.5%)were diagnosed with primary lung cancer with nodal involvement,and 16(20.0%)exhibited benign behavior including tuberculosis,sarcoidosis and reactive lymphadenitis or who had benign follow-up.The diagnostic sensitivity,NPV,and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8%(n=60/64),80.0%(n=16/20),and 95.0%(n=76/80),respectively.In the multivariate analysis,longer short axis of the lymph node(OR:1.200,95%CI:1.024-1.407;P=0.024)and synchronous lung lesion(OR:19.449,95%CI:1.875-201.753;P=0.013)were independently associated with malignant intrathoracic lymphadenopathy.No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy,and no major complication was observed.CONCLUSION EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.
