原发性颈淋巴结结核的临床特征与治疗

目的：探讨原发性颈部淋巴结结核的临床特征和治疗方法。方法：回顾性分析32例原发性颈部淋巴结结核患者的临床资料。32例患者中29例活检前行CT检查,4例行细针穿刺针吸活检确诊,28例行手术病理检查确诊。27例行肿块全部切除或区域性颈部淋巴结清扫术,术后全身抗结核治疗6个月;5例确诊后行常规抗结核治疗1年。结果：CT显示肿块呈均匀或不均匀强化,部分肿块呈融合现象。全部病例治疗后均行随访,手术患者术后切口均Ⅰ期愈合,1例术后抗结核治疗3个月肿块增大,再次手术确诊为颈部淋巴结结核并发鼻咽癌颈部淋巴结转移,转肿瘤科治疗,其余31例患者均无颈部淋巴结结核复发和其他结核病表现。结论：原发性颈部淋巴结结核临床特征发生改变,颈部肿块为首发症状,多数位于颈后三角区。CT检查有助于本病的诊断和鉴别诊断。全身抗结核药物和手术切除淋巴结的联合应用能有效地治疗原发性颈部淋巴结结核。原发性颈部淋巴结结核的治疗应以手术为主,手术治疗能缩短治疗时间、减少药物用量及不良反应,防止冷脓肿及窦道形成。     

Mycobacterial cervical lymphadenitis: role of surgery

OBJECTIVE: To discuss the place of surgery in the management of mycobacterial cervical lymphadenitis. PATIENTS AND METHODS: It's a retrospective study (1982-2002) about 246 patients treated in the ENT department of Farhat Hached Sousse for cervical lymph node tuberculosis. Resolution was considered when neither symptoms nor lymphadenopathy in examination were noted. RESULTS: The mean age of our patients was 28 years. A light female prevalence was noted. In 5 patients diagnosis was established by lymph node punction. A medical treatment of first intention was then managed with a failure in 3 cases, after deadlines from 3 to 4 months. All other patients were operated: cellulolymphadenectomy (47%), adenectomy (47%) or drainage of a cervical abscess (4%). Recurrence and antituberculosis treatment resistance were noted respectively in 6% and 3% of cases. DISCUSSION: Two questions are still discussed in the management of mycobacterial cervical lymphadenitis: 1- Is surgery necessary for the diagnosis? 2- When is surgery indicated directly? Histological specimen established the diagnosis in all cases and excluded a mestastatic lymph node. In some situations surgery must be indicated at first: cold abscess, lymph node fistulation. CONCLUSION: Surgery still has an important place in the treatment of tuberculosis lymphadenopathy.     

Source of tubercle bacilli in cervical lymph nodes: a prospective study

A prospective study searching for associated mycobacterial infection of the upper aerodigestive tract in patients with cervical tuberculous lymphadenitis (TBLN) was carried out. One hundred and thirteen patients with a clinical suspicion of cervical TBLN were included. All patients had a physical examination of the upper aerodigestive tract. Routine endoscopy and biopsy of the nasopharynx were performed. All of them had surgery to the cervical lymph node. Seventy-five patients had histologically confirmed cervical TBLN. Culture of the lymph node specimen showed Mycobacterium tuberculosis in 68 (90 per cent). In 45 (60 per cent) patients with cervical TBLN the primary foci of infection could not be found. Twenty-nine (39 per cent) had radiographic evidence of active or healed pulmonary tuberculosis. Sputum culture from two patients showed Mycobacterium tuberculosis. Five patients (six per cent) had tuberculous nasopharyngitis. In one of them (one per cent) the tuberculous nasopharyngitis was primary as no other evidence of mycobacterial infection was found. In the present study, mycobacterial infection of other parts of the upper aerodigestive tract was not found.     

Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases

ObjectiveThis study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage.Materials and methodsRetrospective study including 18 children with a mean age of 38 months [range: 5–67 months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess).ResultsThe initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series.ConclusionContrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage.     

Atypical mycobacterial tuberculosis--a diagnostic and therapeutic dilemma? Case reports and review of the literature

In immunocompetent preschool children cervical lymphadenitis is a common clinical presentation of atypical mycobacteria. Its rapid diagnosis and treatment is still a challenge, because accurate diagnostic procedures for atypical mycobacteria are still not yet available in routine practice. Two children suffered from craniojugular (16 months old girl) and infraauricular (2.5 years old boy) located neck masses which showed resistance to the medical treatment. In the first case an abscess splitting took place initially, followed by an anti-tubercular drug treatment and necessary surgical reintervention. In the second case surgical removal of all involved lymph nodes, infiltrated surrounding soft tissue and involved skin areas were followed by medical treatment. In both cases presumed infection with mycobacterium tuberculosis was not confirmed, but atypical mycobacteria could be isolated both. In the first case atypical mycobacterium could be specified as mycobacterium avium complex and in the second case as mycobacterium malmoense. Both bacilli showed sensitivity towards medical treatment with clarithromycin, whereby in one case only the surgical reintervention led to a complete removal of clinical symptomatic. In cases of presumed tuberculous neck lymph node infections differential diagnosis of an atypical mycobacterial lymphadenitis should always be supposed, because medical and surgical treatment differ fundamentally.     

Distribution of Lymph Nodes in the Neck in Cases of Tuberculous Cervical Lymphadenitis

Objective —To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period.

Material and Methods —This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of >6 weeks duration.

Results —Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and >2 groups in 13% of patients.

Conclusions —These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology.     

Prognostic importance of harvested lymph node number,metastatic lymph node number,and lymph node ratio in surgically managed laryngeal squamous cell carcinoma

IntroductionLymph node metastasis is a well-known prognostic factor for laryngeal carcinoma. However, current nodal staging systems provide limited information regarding prognosis. Additional parameters should be considered to improve prognostic capacity.ObjectivesTo assess the prognostic values of metastatic lymph node number, ipsilateral/contralateral harvested lymph nodes, and lymph node ratio in patients undergoing surgical treatment of laryngeal squamous cell carcinoma.MethodsSeventy-four patients diagnosed with laryngeal squamous cell carcinoma primarily managed surgically were included in this study. The patients’ pathological and survival data were obtained from their medical records. The effects of harvested lymph nodes and lymph node ratio on disease-free survival, disease-specific survival, and overall survival were analyzed.ResultsIpsilateral, contralateral, and bilateral evaluations of harvested lymph nodes showed no significant associations with prognosis. Lymph node ratio was significantly associated with overall survival when evaluated bilaterally. Metastatic lymph node number showed more suitable stratification than TNM classification.ConclusionsMetastatic lymph node number and bilateral lymph node ratio parameters should be taken into consideration to improve the prognostic capacity of TNM.     

Kikuchi-Fujimoto disease mimicking thyroid metastasis

INTRODUCTION: Kikuchi-Fujimoto lymphadenopathy is a subacute necrotizing lymphadenopathy of unknown origin. It usually affects cervical lymph nodes. Lymph node biopsy is needed for establishing the diagnosis. This disease must be considered as a possible cause of lymphadenopathy of unknown origin, certainly if classical clinical features lead to diagnostic confusion. OBSERVATION: A 41-year-old female presented a thyroid cancer treated by thyroidectomy associated with administration of I131. She also presented a right cervical metastasis treated by surgery. She had a cervical right cervical lymphadenopathy, hypermetabolic on the FDG scan, treated by a modified neck dissection. Microscopy of the surgical specimen showed necroziting lymphadenitis. DISCUSSION: Kikuchi-Fujimoto lymphadenopathy is a subacute necroziting lymphadenopathy of unknown origin, involved more commonly cervical lymph nodes unilaterally. It is more common in Asia, predominantly in young women. This lesion has been reported in patients of virtually any age or gender. No specific biological findings have been described. Lymph node biopsy is needed for establishing the diagnosis. The spontaneous course is usually favorable but one fatal case has been reported.     

The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review

PurposeDetermine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.Materials & methodsRetrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.Results75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.ConclusionParotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.     

颈淋巴结结核临床分析

目的探讨颈淋巴结结核的临床特点、诊断及治疗方法。方法回顾性分析2004年10月～2011年5月我院收治的83例颈淋巴结结核患者的临床资料。结果 83例颈淋巴结结核患者,女性多见;肿块位于颈侧中上部30例(36.1%),锁骨上窝32例(38.6%);合并肺结核的12例(14.5%);31例行颈部CT扫描,21例增强扫描表现为肿物环形强化;11例行淋巴结针吸活检,8例确诊,其余3例经淋巴结活检确诊;3例抗结核治疗无效。结论颈淋巴结结核以颈侧部和锁骨上窝肿块为主要表现,部分合并肺结核;颈部增强CT扫描有重要的诊断价值;针吸活检不能确诊的应尽早手术活检;多数患者只需行抗结核治疗,无效者需行手术治疗。     

Risk factors for positive sentinel lymph nodes in head and neck melanoma — a survival analysis

IntroductionSentinel lymph node biopsy is the gold standard procedure for head and neck cutaneous melanoma staging.ObjectiveTo evaluate the technical aspects, positivity and prognostic effect of the cervico-facial sentinel lymph node biopsy.MethodsRetrospective, unicentric study. From 2009 to 2014, 49 patients with cutaneous melanoma of the head and neck underwent surgery at Instituto do Câncer do Estado de São Paulo (ICESP).ResultsOf the 49 patients, 5 had cervical metastasis at the moment of admission. Clark, Breslow and mitotic index were predictors of death. Among the 31 patients undergoing sentinel lymph node biopsy, 3 had positive sentinel lymph nodes (9.7%). Deaths were recorded in two of the cases with positive sentinel lymph nodes (66.6%), and in 5 (17.8%) of the patients with negative lymph nodes. The mean Breslow index was 11.3 mm for primary melanomas with positive sentinel lymph nodes and 4.3 mm for those with negative sentinel lymph nodes. Positivity was associated with Clark and Breslow levels. Malar location showed a protective effect on prognosis. The mean survival for patients with a mitotic index <3.5 was 181 months and 63.4 months for those with a mitotic index >3.5.ConclusionThe frequency of positive sentinel lymph node biopsy in patients with malignant melanoma of the head and neck was lower than in other studies, although the sample consisted of individuals with advanced melanomas. The mitotic index was important for prognosis prediction.     

Inflammatory pseudotumor of the lymph nodes. A case report

Inflammatory pseudotumor of the lymph nodes is a little-known condition characterized mainly by cervical lymph node enlargement, hematological manifestations, and major constitutional symptoms in most patients. The diagnosis is histological, after surgical removal of an involved lymph node. Histologically, stromal proliferation and neovascularity are present, as well as lymphocytic infiltration. This disease is considered benign because of its tendency toward spontaneous resolution, even though symptoms are usually intense. A male patient presented cervical lymph node enlargement, constitutional syndrome, and hematological manifestations, including oscillating thrombocytopenia, leukopenia, and increased ESR. The diagnosis was inflammatory pseudotumor of the lymph nodes, a rare disease. The evolution is torpid but the prognosis is good. This disease should be considered in the differential diagnosis of tumors of the neck region.     

颈淋巴结结核临床分析

目的 分析颈淋巴结结核的临床表现及诊治。方法　回顾性分析我院2007～2015年收治100例颈淋巴结结核患者临床资料。结果　纳入患者多以颈部肿块就诊,仅8例伴有低热、盗汗、乏力等全身中毒症状。95例患者经术后病理检查确诊,15例患者术前经细针穿刺确诊。共95例患者接受手术治疗,术后行全身标准抗结核治疗6个月;余 5例患者予以全身标准抗结核治疗,取得满意疗效。手术方式主要有单纯颈淋巴结切除术31例、颈淋巴结清扫术53例和脓肿切开清创术11例,所有患者随访均无复发。结论 颈淋巴结结核的临床表现复杂,细针穿刺活检阳性率不高,术后病理检查有助于进一步明确诊断,外科手术联合术后全身规范抗结核治疗可作为颈淋巴结结核的治疗方法。     

Redefining parapharyngeal space infections

OBJECTIVES: Our intent was to review the clinical signs, computed tomography (CT) scans, treatment, and outcome of parapharyngeal space infections (PPIs), and to define 2 types of infections of the parapharyngeal space (PPS) according to the location of the infectious process. METHODS: We performed a retrospective analysis of patients hospitalized in a tertiary university hospital with a diagnosis of PPI, abscess, or deep neck abscess between 1988 and 2004. Files and CT scans were reviewed after classification into 2 groups: 1) infection located in the posterior part of the PPS (PostPPI); and 2) infection located in the anterior part of the PPS (AntPPI). RESULTS: Twenty-two patients had a PostPPI; their ages ranged from 10 months to 24 years. Five patients underwent surgical drainage, and 17 others were treated solely with intravenous antibiotic therapy. No pus was found during surgery in 2 patients. The average time of hospitalization was 10 days. Only 1 complication (aspiration pneumonia) was observed. Seven patients had an AntPPI; their ages ranged from 1.5 years to 65 years. All patients underwent surgical drainage, and pus was detected in all cases. The average time of hospitalization was 35 days. Complications (septic shock, respiratory arrest, mediastinitis, pleural empyema, pericarditis) were observed in 4 patients. CONCLUSIONS: The term "parapharyngeal abscess" was assigned long before the CT scan era, and was based on physical examination and plain film radiology. In essence, the entity PPS "abscess" or "infection" is composed of 2 different disorders. Infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and with no extension into other cervical spaces except the adjacent retropharyngeal space may be termed posterior parapharyngeal infection or parapharyngeal lymphadenitis. This is a relatively benign condition, and nonsurgical treatment should be considered. Infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. Urgent surgical drainage is therefore mandatory.     

组织细胞坏死性淋巴结炎11例临床分析

目的：探讨组织细胞坏死性淋巴结炎的临床特点。方法：回顾性分析11例组织细胞坏死性淋巴结炎的临床表现、淋巴结活检病理学特点及其诊治。结果：所有患者均有颈部淋巴结肿大和持续性发热,大多数患者白细胞减少、血沉增快。11例患者均由颈部淋巴结活检确诊。淋巴结活检病理学特点为不同程度的凝固性坏死伴多种形态的组织细胞、淋巴细胞浸润,无中性粒细胞浸润。应用疗程为2～4个月的肾上腺皮质激素治疗,疗效显著,未复发。结论：组织细胞坏死性淋巴结炎的临床表现无特异性,较易误诊,确诊主要依靠淋巴结活检。     

Simultaneous mycobacterial infection of tonsil and cervical lymph node: Evidence to portal of entry

Mycobacterial infections are the group of disease caused by Mycobacterium tuberculosis and atypical mycobacterium. Tuberculosis is a systemic disease, which causes common cervical lymphadenitis as extrapulmonary symptoms. Differential diagnosis of atypical mycobacterial infection and tuberculosis by scanning techniques/radiographing imaging, histopathological evaluation and culturing is important due to their different treatments. Most of this systemic disease is curable with antituberculosis therapy. Atypical mycobacteria generally cause local cervical infections. These microorganisms are resistant to the medical therapy, treated by surgical management.In this article, 12-year-old boy admitted with tonsil hypertrophy and unknown bilateral jugulodigastric mass presented. Histopathologic examination of tonsillectomy material was reported as granulomatous inflammation considered primarily tuberculosis and nontuberculosis mycobacterium (NTM). Atypical mycobacteria were isolated from fine needle aspiration biopsy of cervical lymph node. Although antituberculosis regimen had been given to the patient for 18 months, there was no regression in lymphadenopathies. So bilateral selective cervical lymph node dissection was performed and all lymph nodes at this region were excised. There is no recurrence during 3-year follow-up period. The present case showed us, NTM can infect oral cavity and mucosa and spread to cervical area.     

Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume

ObjectiveThe purpose of this study was to evaluate the usefulness of ultrasound (US) volume measurement of the cervical lymph nodes for diagnosing nodal metastasis in patients with head and neck cancer using a node-by-node comparison.MethodsThirty-four consecutive patients with head and neck cancer from one tertiary university hospital were prospectively enrolled from 2012 to 2017. Patients with histologically proven squamous cell primary tumors in the head and neck region scheduled to undergo a therapeutic neck dissection were eligible. For each patient, 1–4 target lymph nodes were selected from the planned neck dissection levels. Lymph nodes with thickness >20 mm or in a cluster were excluded. Node-by-node comparisons between the pre-operative US assessment, the post-operative actual measurements and histopathological results were performed for all target lymph nodes. Quantitative measurements, such as three diameters, ratios of the three diameters and volume were analyzed in this study. Lymph node volume was calculated using the ellipsoid formula.ResultsPatients comprised 28 men and 6 women with a mean age of 60.0 years (range, 29–80 years) at the time of surgery. In total, 67 target lymph nodes were analyzed in this study and the thickness ranged from 3.9 to 20.0 mm (mean 8.0 mm). There was a strong correlation between the US volume and post-operative actual volume (ρ = 0.87, p < 0.01). The US volume measured 2156 ± 2156 mm³ for the tumor positive nodes, which was significantly greater than the US volume of 512 ± 315 mm³ for tumor negative nodes (p < 0.01). Significant differences between tumor positive and tumor negative nodes were found in five variables (volume, thickness, major axis, minor axis and ratio of minor axis to thickness) for total lymph nodes. To identify predictors of lymph node metastasis, ROC curves of the US variables of target lymph nodes were compared, of which 4 variables were considered acceptable for predicting the lymph node metastasis: volume (AUC 0.86), thickness (AUC 0.86), major axis (AUC 0.79), and minor axis (AUC 0.79) for total lymph nodes. The optimal cut-off level for US volume in total lymph nodes was found to be 1242 mm³, whereby a 62% sensitivity and 98% specificity was reached (likelihood ratio: 25.2).ConclusionPre-operative ultrasonic volume measurement of the cervical lymph nodes was useful for early detection of cervical nodal metastasis in head and neck cancer.     

Distribution of lymph nodes in the neck in cases of tuberculous cervical lymphadenitis

OBJECTIVE: To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period. MATERIAL AND METHODS: This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of >6 weeks duration. RESULTS: Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and >2 groups in 13% of patients. CONCLUSIONS: These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology.     

甲状腺乳头状癌合并颈部局灶型Castleman病1例

摘要：目的探讨甲状腺乳头状癌(PTC)合并颈部局灶型Castleman病 (UCD)的临床诊治经验。方法回顾性分析1 例PTC合并颈部UCD的临床病例资料,并检索国内外文献。该患者术前行甲状腺结节穿刺细胞学检查(FNA)倾向PTC,合并右颈侧区淋巴结肿大,行甲状腺右侧腺叶合并峡部切除及右颈II、III、IV、VI区淋巴结清扫术。结果术后切口愈合良好,无声音嘶哑及低钙症状,术后 4 d治愈出院。术后随访6个月无复发。术后病理证实颈侧区肿大淋巴结为UCD。结论PTC合并UCD极为罕见,且UCD的术前诊断较为困难,但手术切除多可治愈;PTC合并颈部淋巴结肿大者,临床医生不仅需考虑甲状腺癌转移淋巴结可能,还需警惕UCD的存在。     

Tuberculous and non‐tuberculous cervical lymphadenopathy incidence and distribution in Somalia from 2016 to 2020: A review of 241 cases

ObjectiveTo determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings.MethodsIn this hospital‐based retrospective study, the demographic characteristics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)‐guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed.ResultsOf 241 patients 118 men and 123 women (mean age 27.9 ± 18.1 years) included in the study, 46.1% (n = 111) were diagnosed as necrotizing granulomatous lymphadenitis (caseified, consistent with TBL) and 21.6% (n = 12, atypical lymphoid cells and n = 40, metastases) as malignancy. The most common type of metastasis was squamous cell cancer (n = 31), and the primary source of most of them was esophageal cancer (16/31, 51.6%). The age of patients with TBL was significantly lower than that of non‐TBL (21.9 ± 14.6 vs. 41.9 ± 24.6, P = 0.003) and the incidence of TBL in pediatric patients was statistically higher (58.0% vs. 21.5%, P = 0.019). The rate of patients with TBL being localized at level 4 and level 5 was significantly more than non‐TBL patients (18.0% vs. 10.0% and 23.4% vs. 10.8%, respectively, P = 0.01). Half of patients with TBL who have chest radiography had pathological findings; consolidation and bronchopneumonia were present in 52.6% of them. There were 2 patients with paravertebral abscess and one patient with gastrointestinal tuberculosis.ConclusionIn Somalia, in the presence of cervical lymphadenopathy, after diagnosis by using US‐guided biopsy; primarily considering of TBL and malignancy, thoracic involvement should be investigated, and esophageal carcinoma must be excluded in terms of metastatic lymph node.