鼻咽结核12例临床分析

目的 :提高临床上对鼻咽结核的认识。方法 :对 12例鼻咽结核进行回顾性分析 ,总结其临床特征。仅 1例有肺部结核史 (8.3% ) ,9例以颈部包块为首发临床表现 (83.3% ) ,9例初诊时误诊为鼻咽部恶性肿瘤(75 .0 % )。结果 :全部病例经正规抗结核药物治疗后痊愈。经 6个月～ 2年随访无复发。结论 :鼻咽结核更常见的可能是一种单独发生的上呼吸道结核病变 ,并可引起颈淋巴结肿大。颈淋巴结肿大时要注意排除鼻咽结核并与鼻咽部恶性肿瘤相鉴别。抗结核药治疗是鼻咽结核的有效治疗方法     

Sinus histiocytosis with massive lymphadenopathy (rosai-dorfman disease): Report of a case with respiratory tract involvement

The term “sinus histiocytosis with massive lymphadenopathy,” introduced in 1969 by Rosai and Dorfman, refers to a newly recognized disease entity characterized by painless cervical lymphadenopathy, fever, leukocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. The typical course is one of insidious onset, protracted duration of the active disease state, and eventual spontaneous remission, occasionally with subsequent recurrences. Lymph nodes other than those in the cervical area may be involved, and extranodal involvement can occur (such as in the orbit, skin, or respiratory tract). Clinically, this entity may closely simulate malignant lymphoma or nonneoplastic conditions with lymphadenopathy. We present a case in which this disease process extensively involved the respiratory tract and produced obstructive symptoms. The otorhinolaryngologist should be aware of this disease entity and should include it in the differential diagnosis for patients with cervical lymph node enlargement or bronchial obstruction.     

Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible.     

Clinical issues of tuberculous cervical lymphadenitis: evaluation of 5 cases with packet formation]

Cervical lymphadenopathy with packet formation as the sole presentation of tuberculosis is very rarely seen in modern Japan. During the four years from 1987 to 1990, 5 cases of cervical scrofula with packet formation were treated with selective neck dissection followed by antituberculous chemotherapy at the ENT-department of Haibara General Hospital. Clinical evaluation of these cases suggested the following: 1) The physician must keep in mind that cervical scrofula should be included in the differential diagnosis of any neck masses, and malignant neck tumors particularly should be differentiated from cervical scrofula. 2) The treatment of cervical scrofula should be appropriate to the clinical stage diagnosed by CT or MRI. Recommended therapy for cervical scrofula with packet formation is selective neck dissection followed by antituberculous chemotherapy, which can shorten the period of treatment. 3) We present here a 22-year-old female from the Philippines with cervical scrofula and suggest that, in the future in Japan, tuberculosis may frequently be encountered in the immigrant population from the countries with high incidences of tuberculosis.     

Clinical value of fine needle aspiration cytology in pediatric cervical lymphadenopathy patients under 12-years-of-age

Objective

The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric cervical lymphadenopathy in patients under 12-years-of-age.

Methods

A retrospective chart review was performed to evaluate patients under 12-years-of-age with cervical lymphadenopathy who underwent lymph node excision biopsy from January 2007 to June 2013. The results of FNAC were compared them with the corresponding histopathological diagnosis.

Results

Eighteen of the 27 patients had undergone FNAC before performing excision biopsy, which diagnosed benign diseases in 15 patients and malignant diseases in three patients. All 18 patients underwent excision biopsy. FNAC had a diagnostic sensitivity of 100%, positive-predictive value of 93.3%, and accuracy of 94.5% for diagnosing pediatric cervical lymphadenopathy.

Conclusions

FNAC is a useful and accurate adjunct for the evaluation of pediatric cervical lymphadenopathy. FNAC should be part of the initial evaluation of pediatric patients with cervical lymphadenopathy before determining the treatment plan     

Poorly differentiated adenocarcinoma arising from a cervical bronchial cyst

Bronchogenic cysts with malignant change are rarely reported. We describe a case of poorly differentiated adenocarcinoma arising from a cervical bronchial cyst in a patient presenting with a thyroid mass, cervical lymphadenopathy, and initial biopsy suggestive of papillary thyroid carcinoma. The clinical presentation, intraoperative findings, radiographic images, and pathology slides are presented. To our knowledge, this is the first report of a poorly differentiated adenocarcinoma arising from a bronchial cyst in the cervical region.     

Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect

ObjectivesThe authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect.MethodsA multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.ResultsIn adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).     

Cat scratch disease: a diagnosis to be aware of!

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.     

A retrospective chart review of evaluation of the cervical lymphadenopathies in children

Objective

Cervical lymphadenopathy is a common finding of physical examination in childhood. The aim of this study was to evaluate the etiology and treatment of cervical lymphadenopathy in children.

Methods

Two hundred eighty two patients’ chart reviewed retrospectively who were referred to the Pediatric Oncology Department with cervical lymphadenopathy during the period of November 2007-2009.

Results

A total of 9 children had malignant and 273 children had benign disorders. Excisional biopsies were performed to 35 children. A specific etiology was found in 36% in the benign group.

Conclusion

Primary diagnostic evaluation of childhood cervical lymph node enlargements is based mainly on clinical and physical examinations.     

Syphilitic cervical lymphadenopathy

Syphilis is well known as a great mimic, however it is not recognized as a cause of cervical lymphadenopathy. We report a case of a 21-year-old man who presented with marked unilateral cervical lymphadenopathy. He had no evidence of oropharyngeal chancres, skin or genital lesions. Computed tomography (CT) and magnetic resonance (MR) images showed multiple cervical lymphadenopathy, and serologic tests for syphilis were positive. Syphilis should still be a factor for consideration in the differential diagnosis of cervical lymphadenopathy.     

Rosai‐dorfman disease with extranodal involvement

Rosai‐Dorfman disease is a rare condition of marrow hematopoietic stem‐cell origin. Patients can show extranodal involvement as well as lymphatic involvement, but only about 5% of extranodal cases involve intracranial lesions. A 53‐year‐old male was admitted to our hospital with bilateral cervical lymphadenopathy. Intracranial tumors and bone lesions were also detected. Cervical lymph node biopsy and intracranial tumor resection were performed, and histopathological examination revealed Rosai‐Dorfman disease. The patient showed good clinical course without significant enlargement of the tumor. This study describes the case of a patient with Rosai‐Dorfman disease presenting with massive cervical lymphadenopathy mimicking malignant neoplasm. Laryngoscope, 124:701–704, 2014     

Rosai Dorfman syndrome — A rare clinical entity

Sinus histiocytosis with massive lymphadenopathy (also known as Rosai Dorfman syndrome) is a unique disease of unknown etiology with a childhood predilection. It is an uncommon benign condition, often confused with lymphoma. Patients usually present with massive, painless, bilateral cervical lymphadenopathy and clinical course is variable. This condition has been sporadically reported in Indian literature. Here we report a 26-year-old women presenting with a painless bilateral cervical lymphadenopathy. A FNAC from cervical lymph node was compatible with Rosai Dorfman syndrome and confirmed histopathologically.     

Inflammatory pseudotumour involving the skull base and cervical spine

Inflammatory pseudotumour (IPT) is an idiopathic condition characterized by sclerosing inflammation, which mimics a neoplastic process. IPT involving the skull base and cervical spine is distinctly rare and usually indistinguishable from aggressive neoplasms or infection. We report a case of IPT involving the skull base and cervical spine. Initially the patient complained of headache and hearing loss without other neurological dysfunction. Two cycles of oral systemic steroid therapy resulted in only partial responses. Low dose radiotherapy was followed by quadriparesis as the lesion infiltrated into the cervical vertebral bodies. Subsequently a second course of radiation was administered to the whole cervical spine. Marked improvement was observed clinically and radiologically; however, the patient gradually deteriorated and died of sepsis. Given the aggressive nature of disease and the complications related to the long-term treatment, we suggest that a more aggressive therapeutic approach is suitable in extensive IPT of the skull base.     

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.     

Tonsillar size is an important indicator of recurrent acute tonsillitis

This prospective study was designed to identify important clinical features in patients with recurrent acute tonsillitis. A total of 195 consecutive children aged from 1 to 16 years were examined and a history of recurrent acute tonsillitis recorded. Patients with obstructive sleep apnoea or recent acute tonsillitis were excluded. Tonsil size was measured on the Brodsky scale [Brodsky L. (1989) Paediatr Clin N Am 36, 1551], tonsil symmetry, cervical lymphadenopathy, and hyperaemia of the anterior pillars was recorded. Patients with a history of recurrent tonsillitis had larger tonsils than those without tonsillitis (P < 0.001). Tonsil asymmetry and cervical lymphadenopathy were more common in patients with recurrent tonsillitis (P < 0.001). Anterior pillar hyperaemia was also more frequent in recurrent tonsillitis (P < 0.01). In addition to the frequency and severity of tonsillitis it is suggested that the size and symmetry of the tonsils, plus cervical lymphadenopathy and anterior pillar hyperaemia should be taken into account when deciding which patients would benefit from tonsillectomy.     

Spontaneous bilateral internal jugular vein thrombosis: a sign of metastasis

Head and neck swellings are common referrals to the otolaryngology department, with a wide range of aetiologies. Internal jugular vein thrombosis presenting as swelling in the neck is a rare occurrence. The authors report a case of bilateral internal jugular vein thrombosis secondary to malignant lymphadenopathy of unknown origin. The patient presented with a short history of a diffuse swelling in the neck with neck stiffness. Examination revealed palpable cervical and axillary lymphadenopathy. Causes of spontaneous internal jugular vein thrombosis were discussed.     

Pilomatricoma of the cheek: A benign tumor mimicking metastatic squamous cell carcinoma on FDG PET/CT

Background

Pilomatricomas are benign skin tumors originating from hair matrix cells in the dermal layer of the skin, especially in the head and neck region. They may mimick malignant lesions on fine-needle aspirate cytology.

Methods

This is a case report of a pilomatricoma of the cheek which was initially diagnosed as squamous cell carcinoma on fine-needle aspirate cytology. As part of the staging work-up, a PET/CT scan was performed, revealing a FDG-avid superficial cheek lesion and also an ipsilateral FDG-avid level II cervical lymph node, giving the impression of metastatic squamous cell carcinoma.

Results

The cheek lesion, as well as the cervical lymph node was excised. The final histology showed benign pilomatricoma and reactive lymphadenopathy.

Conclusion

Pilomatricoma should be considered as an uncommon differential diagnosis for an FDG-avid cutaneous lesion on PET/CT, even in the presence of ipsilateral FDG-avid cervical lymphadenopathy.     

Epstein-Barr virus infection as a cause of cervical lymphadenopathy in children

Objective

Cervical lymphadenopathy is a common pediatric problem; reactive hyperplasia, specific infective agents, and malignancy are mainly the differential diagnosis. The aim of our study was to detect the prevalence of Epstein-Barr virus infection among children who complained of cervical lymphadenopathy and also to evaluate the clinical manifestations of the disease in pediatric patients.

Methods

One hundred and sixty children presented with cervical lymphadenopathy were subjected to Epestien-Barr Virus (EBV) serology testing. Cases that showed positivity to heterophile antibody test, and/or EBV-specific antibodies; IgM against viral capsid antigen (VCA-IgM) and IgG against viral capsid antigen (VCA-IgG) were evaluated clinically for manifestations of the disease.

Results

Twenty-four cases (15%) showed positivity to EBV serology, all of them had posterior cervical lymph nodes enlargement, 70.8% had fever, 66.6% had tonsillo-pharyngitis, 58.3% had splenomegaly, 25% had hepatomegaly, 41.6% had generalized lymphadenopathy, while skin rash was detected in 12.5%, and both palatal petechiae and palpebral edema were detected in 8.3%.

Conclusions

EBV infection is not a rare cause of cervical lymphadenopathy in children. Posterior cervical lymphadenopathy in pediatric age group may represent a password for suspicion of EBV infection, while other clinical manifestations of the disease may include hepato-splenomegaly, skin rash, palpebral edema and palatal petechiae.     

CT and US features of cervical lymphadenopathy due to kikuchi’s disease

Kikuchi’s disease or histiocytic necrotising lymphadenitis is a distinct benign clinicopathologic entity which is to be distinguished from malignant conditions, especially lymphoma. We report a young woman with Kikuchi’s disease presenting with cervical lymphadenopathy and mild hepatomegaly. CT and US findings are presented as well as a review of the pertinent literature     

Cystic form of cervical lymphadenopathy in adults. Guidelines of the French Society of Otorhinolaryngology (short version). Part 2–etiological diagnosis procedure: Clinical and imaging assessment

IntroductionThe authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for clinical and radiological assessment of cystic neck lymphadenopathy of unknown primary in adults. Most cases concern head and neck carcinoma metastasis, often in the oropharyngeal area, or less frequently differentiated thyroid carcinoma or non-keratinizing nasopharyngeal carcinoma.MethodsA multidisciplinary task force was commissioned to carry out a review of the literature on the etiological work-up in cystic neck lymphadenopathy in adults: clinical examination, conventional imaging (ultrasound, CT, MRI) and metabolic imaging. Guidelines were drafted based on the articles retrieved, and graded A, B, C or expert opinion according to decreasing level of evidence.ResultsOriented clinical examination, cervical and thyroid ultrasound scan and contrast-enhanced neck and chest CT scan are recommended in the assessment of cystic neck lymphadenopathy of unknown primary in adult patients. PET-CT is recommended prior to panendoscopy, to identify the primary tumor.ConclusionClinical and radiological assessment is fundamental for etiologic diagnosis of cystic neck lymphadenopathy in adult patients, and should be completed by cytological examination before in initiating treatment.