lymphadenopathy

Kimura’s disease (KD) is a rare chronic inflammatory condition of unknown origin. This case report described a unique presentation of KD in a 35-year-old Iranian woman who presented to the Emergency Department in March 2021 with hematuria, proteinuria, diffuse painless, and non-tender white cutaneous lesions affecting the head, neck, chest, and hands, with no swelling. Laboratory assessments showed micro-proteinuria, without oliguria, as well as peripheral serum eosinophilia (10%). Other laboratory findings were unremarkable. Histopathological analysis of skin lesion biopsies showed epidermal focal erosion, hyperkeratosis, parakeratosis, acanthosis, and intact basal layer, as well as dermal interstitial and perivascular infiltration of lymphocytes, histiocytes, and a few eosinophils, with plump endothelial cells in vessels. The diagnosis of KD was confirmed. Hematuria and proteinuria resolved without specific treatment within two days. The skin lesions remained persistent. This case deviated from the typical presentation of KD, as it involved a non-oriental female patient with diffuse cutaneous involvement. Increased awareness of atypical presentations is crucial for preventing misdiagnosis in the evaluation of suspected KD cases.

Sentinel lymph node biopsy (SLNB) is primarily performed to detect axillary lymph node involvement and determine the need for surgical axillary lymph node dissection (ALND). However, the procedure is expensive and necessitates the use of radio-labelled colloids that are not readily available to a large number of patients. It also carries the risk of producing occasional false negative results.

This study aimed to define highly specific ultrasound parameters to ascertain axillary lymph node involvement as an alternative or complementary method to SLNB in selected patients who require ALND.

In this prospective cross-sectional study, 256 patients with confirmed breast cancer were selected through non-probability purposive sampling. The selected patients were referred to Omid Hospital, a tertiary educational oncology center in Mashhad, Iran, from 2018 to 2022. This study identified highly specific cut-off points for ultrasound parameters to determine lymph node involvement in comparison with the histological diagnosis post-SLNB or ALND. Measurements were taken of the tumor size, the cortical thickness of the axillary lymph node, the short axis diameter of the node, and the count of lymph nodes with a cortical thickness of ≥ 3 mm.

Among 256 patients with a mean age of 46.41 ± 10.77 years, 202 (87.9%) had histologically confirmed metastatic adenopathy. The ultrasound cut-off values identified to define metastasis with high certainty were as follows: A tumor size > 50.5 mm (with 97% specificity), a difference in cortical thickness of ≥ 4.5 mm (with 100% specificity), a short axis diameter of the node > 12 mm (with 95% specificity), more than three lymph nodes with a cortical thickness of ≥ 3 mm (with 94.3% specificity), and a cortical thickness of ≥ 6 mm (with 95% specificity).

Highly specific ultrasound findings can diagnose lymph node metastasis with a high degree of certainty and can used as an alternative method to SLNB. A difference of ≥ 4.5 mm between the cortical thickness of the suspected lymph node and the contralateral lymph node and a cortical thickness of ≥ 6 mm are ultrasound findings that can detect lymph nodes involvement, with a specificity ranging from 95% to 100%.

Mutations in the SLC29A3 gene cause histiocytosis-lymphadenopathy plus (H) syndrome, a rare autosomal recessive genetic condition that affects numerous systems. We present a 7-year-old Syrian patient with pericardial effusion whose acute phase reactants did not decrease despite treatment. In order to emphasize the variety and raise awareness of H syndrome in the hopes of achieving an early diagnosis and appropriate treatment, molecular investigation of SLC29A3-related disorders is crucial. H syndrome is an uncommon genetic condition with a broad spectrum of phenotypes. Therefore, early genetic testing is essential for the accurate diagnosis of patients. Doctors should be aware of this condition and its symptoms and consider autoimmune diseases as a possible alternative diagnosis in patients with suspected immunodeficiency.

Primary immunodeficiencies are a diverse group of rare genetic disorders, among which phagocytic dysfunction impairs neutrophil function in a wide range of inherited disorders. Due to the heterogeneity of the disorders a multidisciplinary approach is often required for early diagnosis and initiation of appropriate treatments. The aim of this study was to evaluate the imaging findings in children admitted with phagocytic primary immunodeficiencies.Thirty-five children who fulfilled the inclusion criteria for phagocytic dysfunction were enrolled in this study. The patients were under close observation and monitoring from January 2011 until data locking in December 2017. The diagnosis of phagocytic immunodeficiency was confirmed by the patient’s clinical course, presentation features, and laboratory data. Among the 35 patients studied, the most frequent condition was chronic granulomatous disease (CGD) (23 patients), followed by different types of neutropenia (8 patients) and Job’s syndrome (4 patients). Mediastinal and hilar lymphadenopathies and consolidation were the most frequent presentations. There was a significant relationship between mediastinal/hilar lymphadenopathies and fungal infections. A meaningful relationship was also found between pulmonary nodules without halo signs in patients with concomitant tuberculosis and fungal infections. A significant correlation was found between CGD, pulmonary fibrotic changes, and mediastinal lymphadenopathies.The most frequent radiological manifestations in children included mediastinal and hilar consolidations. Physicians’ awareness of the radiological and clinical manifestations of these inherited diseases may be helpful in the early diagnosis and timely initiation of specific prophylaxis measures to prevent infections and also to initiate hematopoietic stem cell transplantation as the curative management modality.

 Chronic granulomatous disease (CGD) is a primary hereditary immunodeficiency condition caused by a defect in the nicotinamide adenine dinucleotide phosphate (NADP) oxidase complex. Recurrent infections and inflammatory complications with a narrow bacterial and fungal spectrum characterize CGD. Acute inflammatory and infectious complications are vexing and fatal for them. Therefore, managing CGD with prophylactic antibiotics and antifungal agents is essential.

 We present a 23-month-old infant with a chief complaint of recent lymphadenopathy diagnosed with CGD. Two months later, she was hospitalized with uncontrolled fever and lung involvement while receiving prophylactic treatment with trimethoprim/sulfamethoxazole. A mass-like consolidation was seen in her radiography evaluation. Based on the biopsy and bronchoalveolar lavage (BAL) pathology report, pulmonary mucormycosis was confirmed. Two weeks after starting the standard treatment regimen with amphotericin B, the patient’s symptoms improved. She was discharged in good general condition with oral voriconazole and trimethoprim/sulfamethoxazole and referred to do hematopoietic stem cell transplantation (HSCT).

 Mucormycosis in CGD is not a common infection and usually infects patients with impaired cell-mediated immunity, hematological malignancies, steroid treatment, and diabetes. Patients with CGD are vulnerable when treated with a high dose of immunosuppressant medications. In our case report, the patient was infected with mucormycosis despite not receiving immunosuppressant medications and having no history of hematologic malignancies or diabetes. Our patient also had a mass-like consolidation in her radiological result, a rare feature of pulmonary mucormycosis involvement in CGD patients.

Toxoplasma Gondii (TG) is a zoonotic protozoan with extensive symptomatology. Toxoplasmic lymphadenopathy is considered an affirmative sign and is proved by a biopsy of the enlarged nodule. This study was conducted to compare the clinical, serological, and histopathological findings for the diagnosis of toxoplasmic lymphadenopathy.  This study involved biopsy examinations from twelve cases with TG lymphadenopathy. ELISA serological tests were performed for TG specific IgM and IgG immunoglobulins. PCR was done to ratify the results obtained by ELISA.  The ages of the patients ranged from 15 to 48 years (mean=27.8). Most of the cases are male n=8(66.7%), while female n=4(33.3%). The asthenia was not only the most frequent clinical presentation (83.3%), but it also last longer. All cases had a positive biopsy. Eight (67.7%) cases revealed seropositivity. Two of them had positive PCR in those who were positive IgM, suggesting that the infection was acute. Six (50%) cases revealed positive IgG tests, while those with negative serology were 4(33.3%). The site of lymph nodes involvement had been assessed and mostly cervical (91.6%). The histopathological results yielded 100% positive findings, thus biopsy was very important in the diagnosis and differential diagnosis of lymph nodes enlargement. The chronic phase of toxoplasmosis does not show the protozoa in the blood causing an absent DNA band for amplification of the PCR cycles, which could explain the lack of bands particular for TG. A negative serological test does not exclude toxoplasmic lymphadenitis, especially in immune-compromised patients.

Given the children's susceptibility to the harmful radiation of computerized tomography (CT) scans, ultrasonography can be a good alternative in staging pediatric lymphoma. The present study aimed to assess the predictive value of abdominal ultrasonography compared to CT scan in children with lymphoma.

Fifty-two children with confirmed lymphoma were included in the present cross-sectional analytical study and underwent CT scan. The staging was performed based on the involvement pattern, lymph nodes, liver involvement, spleen involvement, and lymph node sizes. Then, the patients underwent ultrasonography followed by re-staging. The data were analyzed by SPSS 26. p-value less than 0.05 was considered statistically significant.

The included patients consisted of 32 (61.5%) boys and 20 (38.5%) girls with the median age of 6.0 years (4.3-8.0). The number of the patients with positive paraaortic lymphadenopathy, iliac chain lymphadenopathy, mesenteric lymphadenopathy, increased liver size, changed liver parenchyma, increased spleen size, changed spleen parenchyma, increased kidney size, and changed kidney parenchyma evaluated by sonography and CT scan were 24 (46.2%) and 26 (50.0%), 3 (5.8%) and 3 (5.8%), 34 (65.4%) and 34 (65.4%), 49 (94.2%) and 48 (92.3%), 23 (44.2%) and 23 (44.2%), 45 (68.2%) and 21 (31.8%), 48 (92.3%) and 48 (92.3%), 50 (96.2%) and 50 (96.2%), and 49 (94.2%) and 48 (92.3%), respectively (p ≤ 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of abdominal ultrasonography staging compared to CT scan were 100%, more than 90%, more than 75%, and 100%, respectively.

Due to the sufficient sensitivity and specificity, ultrasonography has the potential to be applied instead of CT scan for the abdominal staging of pediatric lymphoma.

Primary nasopharyngeal tuberculosis (NPTB) is a rare disease but should not be missed as one of the differential diagnoses for cervical lymphadenopathy or nasopharyngeal mass. 

Case Report:

We describe a case of a 38 year old lady, who presented with bilateral cervical lymphadenopathy associated with intermittent fever. Nasoendoscopy examination and computed tomography scan of the neck revealed a centrally located mass predominantly at the left posterior nasopharyngeal wall without obliteration of both fossae of Rosenmuller. Typical histopathological features of necrotizing granulomatous lymphadenitis together with the common clinical presentation of cervical lymphadenopathy and nasoendoscopy findings of nasopharyngeal mass conclude the diagnosis of nasopharyngeal tuberculosis. With anti-tuberculous therapy, the cervical lymphadenopathy and nasopharyngeal mass were completely resolved.

Nasopharyngeal tuberculosis is an uncommon disease with great diagnostic challenges and with early diagnosis and adequate treatment, NPTB carries a good prognosis with complete disease resolution.

With an increasing rate of lymphadenopathies (LAP) reported following COVID-19 vaccination with various vaccines, which can mimic breast cancer (BC), a comprehensive review, can disclose some practical information about BC workup that reduces the incidence and mortality of the disease along with unnecessary steps.

We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. Keywords of literature search included “COVID-19”, “coronavirus disease”, “Vaccine”, and “Vaccination”, “LAP”, “Adverse event*”, “Lymph node”, “Cancer, breast”, and “Lymphadenopathy”.

In total, 59 studies (n=880 cases), including 412 (46.8%) females, 146 (16.6%) males, and 322 (36.6%) cases with unknown gender were reviewed. We reviewed the LAP presentation after vaccination of the first or second dosage of Pfizer-BioNTech (n=754, 85.7%), Moderna (n=38, 4.3%), Oxford-AstraZeneca (n=39, 4.4%), Sputnik V (n=1, 0.1%), Johnson & Johnson/Janssen (n=1, 0.1%), and CureVac (n=1, 0.1%). In 46 (5.3%) cases, the type of vaccine was not reported. The most common LAP locations were axillary (n=540), followed by axillary and supraclavicular (n=271). We found that imaging findings of LAP associated with vaccination were seen from the first day to two months after vaccination of the first or second dosage of different types of COVID-19 vaccines.

This review study can draw a broad perspective by focusing on patients with cancer, especially BC, for clinicians to proceed with the right approach at the right time without additional invasive measures and not to delay the necessary measures in high-risk patients at the same time.

Congenital generalized lipodystrophy (CGL) presents during the first two years of life. It is a rare autosomal recessive inherited disease with loss of cutaneous fat and various complaints and complications such as diabetes mellitus, hypertriglyceridaemia and hepatic steatosis.

A patient was hospitalized with abdominal distention, weight loss, irritability, and pruritus. Massive hepatomegaly, huge splenomegaly, multiple significant lymphadenopathies, hypertrichosis, generalized subcutaneous fat loss with bird-faced, increased musculature, and prominent superficial veins were detected on examination. In paraclinical evaluation, hyperlipidemia and severe liver fibrosis (grade 5) were diagnosed, and she was discharged as a case of congenital generalized lipodystrophy.

In an approach to a child with hepatosplenomegaly, lipodystrophy should be in mind.

Kikuchi disease is a benign, self-limited, and rare condition presented mainly by lymphadenopathy and fever. Kikuchi disease is more common in women, especially women under 40. We report a 63-year-old Iranian woman presenting with long-term fever, constitutional symptoms, and cervical lymphadenopathy. A lymph node biopsy was done for her, and the diagnosis of Kikuchi disease was confirmed. Kikuchi disease is a self-limited condition with a good prognosis that can resolve with no specific treatment within a few weeks. Still, some patients are at risk of recurrence and development of SLE and Lymphoma. Our patient was treated with a low dose of glucocorticoids. On 6 month follow-up, she had no signs and symptoms of recurrence and no evidence of SLE development. The interesting point of this case is the clinical picture and her age of presentation.

Lymphadenopathy is an enlargement of a lymph node. Pathologic Lymphadenopathy is when there is a symptom of infectious and noninfectious abnormalities or malignant diseases. Most Lymphadenopathies are benign and are associated with a short period of symptoms. Concerning diagnosis and management of adenopathy, especially in the case of children, research is still underway. For this reason, our study investigated and analyzed the causes of lymphadenopathy in children.

This is a retrospective study conducted at the Pediatric Department of children's medical center of Tehran University of medical science. In this study, 130 children with cervical lymphadenopathy aged under 12 years underwent lymph node biopsy. Then under general anesthesia and evaluation of a senior pathologist, the lymph node was excised and biopsied.

During the study, twenty-five cases were excluded. Fifty-three patients (50.47%) demonstrated infection history, 22 cases (21%) had neoplasia, and reactive inflammatory changes with nonspecific origin were seen in 42 cases (40.0%). We observed chronic lymphadenitis in 3(2.9%) cases, and finally, 1(1.0%) case was metastatic. Mean lymph node size proved to be greater than two cm in metastatic (2.22cm), lymphoma (2.33cm), and granulomatous (3.17cm) lymphadenopathies. The average lymph node size turned out to be 1.53 cm in reactive lymph nodes (P =0.021). The diagnosis was obtained by excisional biopsy and histopathology.

Acute infections are the most common reason for lymphadenopathy in pediatric conditions. It is better to be suspicious of malignancy with a high index in cases of cervical lymphadenopathy, especially if the lymph node size is higher than 2 cm. History, clinical features, and paraclinical tests can be used for lymphadenopathy in children.

Core needle biopsy (CNB) guided by imaging modalities seems to be an acceptable modality for diagnosis of lymphoma due to its safety, good applicability, availability as well as diagnostic accuracy, however; Studies have not reached a consensus on its diagnostic accuracy and factors affecting its performance. The present study aimed to assess the value of ultrasound-guided cervical CNB in the diagnosis of lymphoma in suspected patients.

This cross-sectional study was performed on 46 consecutive patients (20 to 82 years) with cervical mass or lymphadenopathy suspected of lymphoma and were candidates for diagnostic evaluation. Ultrasound-guided core needle biopsies (UGCNB) were done by a single radiologist under guided ultrasonography. The diagnostic value of UGCNB in the diagnosis and determination of specific lymphoma subtypes was assessed.

Using UGCNB led to the diagnosis of lymphoma in 34.8% and non-lymphoma lesions in 43.5%, while the diagnosis remained unclear in other 21.7% with a total UGCNB-based identification rate of 78.3%. No patient with lymphoma was missed. All patients were followed up over a 6-month period. In none of the cases, clinical diagnosis and treatment response were found contrary to the initial pathologic diagnosis. No significant complication such as hematoma or infection was reported.

UGCNB has a high diagnostic value for determining the nature of the cervical lesions suspected of lymphoma.

Lymphadenopathy is one of the commonly encountered clinical presentation and the early targets for aspiration, therefore providing an important clue towards the diagnosis to find out the underlying etiology.

The present cross-sectional prospective study was conducted in the tertiary care hospital in the North India among 201 lymphadenopaty patients on whom fine needle aspiration cytology (FNAC) was performed after the informed consent.

In the currnt study, majority of the patients were male (52.73%) with male-to female ratio of 1.1:1. The age group ranged from 1 to >80 years with majority of the patients in the age group of 21 to 30 years followed by 0 to 10 years and least in >80 years. Non-neoplastic cases were 121, neoplastic cases were67, and inadequate were 13 of the total 201 cases.

FNAC of the enlarged lymph node yields an important diagnostic clue to arrive the final diagnosis.

Kimura disease is a rare entity causing subcutaneous swellings and lymphadenopathy, with hardly 120 cases reported worldwide. It is mainly seen in Asian men. Herein, we present a typical case that presents with submandibular mass and persistent eosinophilia. The patient was a 38-year-old man suffering from left submandibular mass for the last 5 years. It has happened upon a dental infection. Treatment with prednisolone resulted temporary decrease in the size of the lesion, but it wouldn't disappear totally. Since the swelling did not get improved, an excisional biopsy was conducted. The high rate of the eosinophil and histopathology results conducted us to diagnose him with Kimura.Histologically, Kimura disease presents as lymphadenopathy with preserved lymph node architecture and reactive and prominent germinal centers. Dense eosinophilic infiltration of the interfollicular zones, lysis of the follicles, and occasionally microabscesses are seen. Granuloma formations contain infiltration of eosinophils, lymphocytes, plasma cells, and histiocytes. Tissue fibrosis, sclerosis, and vascular proliferation are also present. Vessels remain thin-walled with cubical endothelial cells. This was in line with our patient symptoms.

Cryptococcal infection is a chronic opportunistic infection in patients with the Human Immunodeficiency Virus (HIV). A rare case of cryptococcal lymphadenitis is presented here in a 27-year-old woman with an enlarged cervical lymph node. Fine needle aspiration from the involved lymph nodes showed variable-sized, rounded yeast cells surrounded by halos with a prominent capsule. Early diagnosis by fine-needle aspiration is essential and reduces morbidity and mortality.

There are conflicting studies on the prevalence of mediastinal lymphadenopathy (LAP) and its relationship to the prognosis of COVID-19 disease. The prevalence varied from 3.4 to 66 percent and more prevalent in patients who died. This study aimed to investigate the mediastinal lymphadenopathy and the disease progression in COVID-19 patients.

In this case-control study, 195 COVID-19 patients were divided into two groups, with the mediastinal lymphadenopathy and without it. In these groups, demographic characteristics, underlying diseases, laboratory results, and outcomes were compared.

The median age in the LAP group was higher than the opposite group (62 vs. 58.5; p= 0.037). SpO2 (85% vs. 90%; P <0.001), lymphocyte count (760 vs. 969; p= 0.02), Neutrophil-to-Lymphocyte Ratio (5.53 vs. 4.41; p= 0.02), and ESR (36 vs. 29; p= 0.03) were significantly correlated with the presence of lymphadenopathy, using the Mann-Whitney Wilcoxon rank test. ICU admission (65.71% vs. 36.87; p= 0.003), mechanical ventilation (31.42% vs. 13.75%; p= 0.022), disease severity (65.71% vs. 40%; p <0.01), length of hospital stay (9 vs. 7; p= 0.039) and mortality rate (40% vs. 21.25%; p= 0.034) were more predominantly observed in the LAP group, using the χ2 test. There was no apparent difference in sex and the underlying diseases among the two groups.

This observation showed a relatively high prevalence of mediastinal lymphadenopathy in COVID-19 patients, which was more common in the elderly with low oxygen saturation. Therefore, LAP may lead to further intensive care needs, more use of mechanical ventilation, high severity of disease, and mortality rate.

Non-Hodgkin’s B-cell lymphoma is a hematological condition with different types based on clinical presentation, pathological features, and therapeutic response, like Diffuse Large B-cell Lymphoma (DLBCL), follicular lymphoma, and Chronic Lymphocytic Leukemia (CLL). We report A 33-year-old male presented with a complaint of unilateral leg swelling, firstly supposed to be a Deep Vein Thrombosis (DVT); however, in multiple Doppler ultrasonography, DVT was ruled out. The patient’s precise history revealed a swollen mass in the left knee region for two months that slowly enlarged and was confirmed with a physical examination. Doppler ultrasonography of the lower extremities conducted in our center presented no sign of deep vein thrombosis; however, it demonstrated some complex conglomerate lymph nodes in the left inguinal compressing the ipsilateral femoral and iliac vein. It also revealed bulky adenopathy, with a 95×65 mm left knee mass. The performed biopsy reported the existence of malignant lymphoma, suggesting the existence of DLBCL. Consequently, he was referred to a hematology/oncology department for appropriate treatment. This unusual presentation of DLBCL and the importance of noticing an accurate history taking and physical examination, instead of conducting unnecessary paraclinical tests (several Doppler ultrasonography in this case), have led us to report this case.