Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

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.

Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

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.

Abdominal lymphadenopathy:An atypical presentation of enteric fever

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.

Features of Computed Tomography Perfusion of Mediastinal Lymphadenopathies:a Pathology-based Retrospective Study

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.

Metastatic Cervical and Supraclavicular Lymphadenopathy from Prostate Mimicking Lymphoma: A Case Series

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.

Efficiency of EBUS-TBNA for diagnosing benign and malignant lymphadenopathy

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.

IMMUNOBLASTICLYMPHADENOPATHY－LIKE T－CELLL YMPHOMA：A CLINICOPATHOLOGIC AND IMMUNOPHENOTYPIC ANALYSIS OF 24 CASES

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.

Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease

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.

First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy

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.

Malignant transformation of biliary adenofibroma combined with benign lymphadenopathy mimicking advanced liver carcinoma:A case report

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.

Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy

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.

Mediastinal lymphadenopathy in COVID-19: A review of literature

A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal,cardiac,or neurological system dysfunction.Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation.Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies.It is commonly found to be associated with malignant diseases,sarcoidosis,and heart failure.Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection.We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection.Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

Therapeutic Effect of Oral Administration and External Therapy of Traditional Chinese Medicine on Cervical Tuberculous Lymphadenopathy

Objective:To analyze the clinical effect and value of oral administration and external therapy of traditional Chinese medicine for treatment of cervical tuberculous lymphadenopathy.Methods:A total of 56 patients with cervical tuberculous lymphadenopathy admitted to our hospital from January 1 to January 2018 were recruited.By using double-blind method,the patients were divided into control group(n=28)and experimental group(n=28).Control group comprised of patients with conventional anti-tuberculosis treatment,while the experimental group comprised of patients treated with oral administration and external therapy of traditional Chinese medicine.Total effective rate,incidence of complication and level of T lymphocyte subsets were compared between the two groups of cervical tuberculous lymphadenopathy patients.Results:Post-treatment data of total effective rate,complication rate,CD3+,CD4+,CD8+,CD4+/CD8+of the experimental group were compared with the control group.P<0.05;statistical analysis showed statistical significance.Post-treatment data of CD3+,CD4+,CD8+,CD4+/CD8+of both control and experimental groups were compared with pre-treatment data.P<0.05;statistical analysis showed statistical significance.Conclusion:Oral administration and external therapy of traditional Chinese medicine possesses significant effect in treatment of cervical tuberculous lymphadenopathy.

Generalized lymphadenopathy as an atypical initial clinical manifestation in rheumatoid arthritis and a possible hypothetical mechanism

Objective:To describe a 60-year-old male with diffuse generalized lymphadenopathy preceding a diagnosis of rheumatoid arthritis.Case presentation:The patient was admitted on suspicion of lymphoma.Chest positron emission/computed tomography showed enlarged lymph nodes bilaterally,mediastinum in the perihilar,retroperitoneum,and inguinal regions,with normal hematopoiesis of bone marrow.Lymph node biopsy revealed reactive follicular lymphadenopathy.Polyarthritis was present,and a rheumatoid factor test was positive eight months after the initial medical evaluation.A diagnosis of rheumatoid arthritis associated with generalized lymph node involvement was made.The patient was treated with leflunomide and corticosteroids and showed complete recovery without recurrence at 18 months of follow-up.Conclusions:Once histological findings of reactive lymph node hyperplasia are established as primarily related to rheumatic disease activity,clinicians should consider a possible diagnosis of rheumatoid arthritis.

淋巴细胞变异型嗜酸性粒细胞增多症一例并文献复习

淋巴细胞变异型嗜酸性粒细胞增多症(lymphocytic variant of hypereosinophilic syndrome,L-HES)是一种异常的克隆T淋巴细胞引起的嗜酸性粒细胞增多症,其特征为骨髓或外周血中存在表型异常的T淋巴细胞群。本文报道一例49岁L-HES男性患者,嗜酸性粒细胞增多症病史13年,半年前出现全身多处淋巴结肿大,病理示皮病性淋巴结炎,伴反应性增生及嗜酸性粒细胞浸润。骨髓流式细胞术检测示嗜酸性粒细胞比例增高(19.3%),异常T淋巴细胞群,免疫表型为CD3(-)CD4(+)CD8(-)CD5brightCD7(-)。给予口服甲泼尼龙36 mg/d好转,出院后甲泼尼龙减量至8 mg/d维持治疗可控制病情。

超声检查辅助CT或MRI评估放疗头颈癌患者颈部淋巴结肿大的研究

目的本研究旨在评估超声(US)加/不加细针吸取细胞学(FNAC)和计算机断层扫描(CT)/磁共振成像(MRI)评估接受放射治疗的头颈癌患者颈淋巴结病(LAP)的诊断性能。方法回顾性分析269名在2014年1月至2023年1月期间接受放射治疗(RT)或同期放化疗(CCRT)的头颈部癌症患者。诊断方法包括:(1)单纯CT/MRI;(2)CT/MRI结合放疗后超声预测模型;(3)CT/MRI联合US+FNAC。我们使用ROC曲线比较了它们的诊断性能。结果总共观察到141个(52%)恶性淋巴结和128个(48%)良性淋巴结。在诊断准确率方面,CT/MRI和US+FNAC联合检查的ROC曲线下面积最高(0.965),其次是联合CT/MRI和放疗后US预测模型(0.906)和单独CT/MRI(0.836)。结论在评估接受放射治疗的头颈部癌症患者的LAP时,在诊断复发或持续性结节疾病方面,在CT/MRI中添加US检查比单独CT/MRI更高的诊断性能。

发热伴淋巴结肿大初诊 163 例病因及临床特征分析

目的探讨以发热伴淋巴结肿大为特征疾病初诊病人的病因分布及临床特征,提高临床对该疾病的认知和诊断能力。方法收集2020年1月至2022年10月在山西白求恩医院初次收治的经淋巴结活检及病理检查诊断明确的163例发热伴淋巴结肿大病人,根据病因分为感染性疾病组(感染组)、非感染性炎症性疾病组(非感染组)、肿瘤性疾病及造血系统疾病组(肿瘤及造血组)、其他类疾病组(其他组),对其性别、年龄、热程、淋巴结肿大特征、伴随症状、实验室资料、淋巴结病理等资料进行分析。结果163例病人中,感染组63例(38.7%)、非感染组32例(19.6%)、肿瘤及造血组31例(19.0%)、其他组37例(22.7%)。临床特征中,四组间性别、年龄、淋巴结压痛、淋巴结肿大部位(头颈部/胸部/腹部)、合并全身性淋巴结肿大、半年内体质量下降≥10%均差异有统计学意义(均P<0.05)。实验室检查结果中,四组间白细胞计数、中性粒细胞百分比、血小板计数、总胆红素、C反应蛋白、降钙素原、红细胞沉降率、抗核抗体阳性均差异有统计学意义(均P<0.05)。结论发热伴淋巴结肿大主要病因是感染性疾病,其次为其他类疾病,前者病毒感染多见,后者以组织坏死性淋巴结炎为主。临床可通过病人基本情况、临床特征、实验室检查进行初步鉴别诊断,淋巴结活检对诊疗有一定帮助。

PI3Kδ过度活化综合征7例报道

目的总结7例PI3Kδ过度活化综合征(activated phosphoinositide 3-kinase delta synd rome,APDS)患儿的临床资料,提高对该病的认识。方法回顾性分析2019年1月—2023年8月湖南省人民医院收治的7例APDS患儿的临床资料。结果7例患儿(男4例,女3例)中位发病年龄为30个月,中位诊断年龄为101个月。临床表现:反复呼吸道感染、肝脾大及多部位淋巴结肿大7例,脓毒血症5例,中耳炎及多发性龋齿3例,腹泻及关节痛2例,淋巴瘤、系统性红斑狼疮各1例。4例患儿行纤维支气管镜检查,管腔内均可见大量散在的结节样突起。最常见的呼吸道病原为肺炎链球菌(4例)。6例患儿为p.E1021K位点错义突变,1例为p.434-475del位点剪切突变。结论p.E1021K是APDS患儿最常见的突变位点。对于具有反复呼吸道感染、肝脾大、多部位淋巴结肿大、中耳炎、龋齿等表现1项或多项,且纤维支气管镜下见散在结节样突起的患儿,需警惕APDS。

误诊为面部炎症的Rosai-Dorfman病1例

Rosai-Dorfman病是一种罕见的非朗格汉斯细胞组织细胞增生症,其病因及发病机制尚未完全阐明,发生在颌面部更为罕见,本文就1例首诊误诊为口腔疾病造成的面部炎症、终诊断为Rosai-Dorfman病的病例进行报道,结合文献对其临床特点、诊疗及预后进行讨论,为今后诊断和鉴别发生在面颊部的Rosai-Dorfman病提供参考。

模仿IgG4相关淋巴结病的多中心型Castleman病:易误诊病例的鉴别诊断及文献复习

目的通过学习1例少见的组织学特征与IgG4相关性淋巴结病类似的浆细胞型特发性多中心型Castleman病(PC-iMCD),总结两种易误诊疾病的鉴别要点,提高病理诊断水平。方法回顾性分析1例PC-iMCD患者临床资料,常规苏木素-伊红(HE)染色分析淋巴结组织结构及细胞形态,免疫组织化学染色及原位杂交分析免疫表型及EB病毒(EBV)感染状态,并结合文献分析讨论其与IgG4相关淋巴结病的鉴别诊断。结果48岁女性患者,临床表现为口干、多饮、皮肤瘙痒伴全身多处淋巴结肿大。实验室检查血清IgG、IgA、IgM及IgE水平均升高,血清IgG4显著升高(14.7 g/L),白介素-6(IL-6)异常升高(150.84 pg/mL)。病理检查显示淋巴结生发中心萎缩,套区淋巴细胞呈“洋葱皮”样围绕生发中心排列,滤泡间区扩张,其内见大量成熟的浆细胞呈片状浸润,灶区见含铁血黄素沉积及血管增生;免疫组化染色显示IgG4阳性浆细胞数大于100/高倍视野,IgG4阳性细胞/IgG阳性细胞比值>40%,Kappa及Lambda轻链呈非限制性表达;EB病毒编码RNA原位杂交(EBER)阴性。结论部分PC-iMCD与IgG4相关淋巴结病具有相似的组织病理学特征,单纯根据组织学及免疫表型难以将两者鉴别,正确诊断需结合IgG4相关病变诊断标准、排除性诊断标准、临床表现及实验室检查综合判断。