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。     

Combined use of fine-needle aspiration cytologic examination and tuberculin skin test in the diagnosis of cervical tuberculous lymphadenitis. A prospective study

A prospective study to evaluate the efficacy of combined use of fine-needle aspiration (FNA) cytologic examination and Mantoux test in the diagnosis of cervical tuberculous lymphadenitis was carried out. Tuberculin reactions were determined in 59 control subjects. Preoperative FNA cytologic examinations and Mantoux tests were performed on 74 patients with cervical lymphadenopathy. The lymph nodes were then excised and examined histologically and cultured for mycobacteria. Forty-eight, 22, and 4 patients had histologically confirmed tuberculous, non-specific, and malignant lymphadenopathy. Fine-needle aspiration cytologic examination alone could detect cervical tuberculous lymphadenitis in 37 patients (77%). The predictive value of a strong tuberculin reaction for mycobacterial infection was 100%. The combined use of a Mantoux test and FNA cytologic examination was able to diagnose 43 (90%) of 48 cases of tuberculous lymphadenitis cervical preoperatively. Combined use of FNA cytologic examination and Mantoux test was efficient in the diagnosis of tuberculous lymphadenitis.     

Polymerase chain reaction detection of Mycobacterium tuberculosis from fine-needle aspirate for the diagnosis of cervical tuberculous lymphadenitis

BACKGROUND: Despite its well-established usefulness in the diagnosis of cervical tuberculous lymphadenitis, fine-needle aspiration cytology (FNAC) has several limitations in its clinical applications, especially when the presence of acid-fast bacilli is not proven. Furthermore, fine-needle aspirate is sometimes inadequate for diagnosis, and the sensitivity and specificity of this technique for cervical tuberculous lymphadenitis has not been firmly established. OBJECTIVE: The authors performed Mycobacterium tuberculosis polymerase chain reaction (PCR) for mycobacterial DNA sequences from the remainder of fine-needle aspirate after cytological examination and evaluated its diagnostic efficacy in clinical situations. METHODS: Conventional diagnostic procedures including FNAC and M tuberculosis PCR were performed simultaneously in 29 cases that had been suspected to be cervical tuberculous lymphadenitis on patients' first visit. The results of FNAC and M tuberculosis PCR were compared with the clinical outcomes after several months of follow-up and pathological results from open biopsy of some cases. RESULTS: Among the 17 cases of cervical tuberculous lymphadenitis diagnosed in clinical situations, M tuberculosis DNA was found by PCR in 13 cases (76.4%). Negative findings on PCR were achieved in 12 cases, which revealed non-granulomatous lymphadenopathy. CONCLUSION: From these results, we conclude that M tuberculosis PCR using the remainder of aspirate for cytological examination is a very useful tool for the diagnosis of cervical tuberculous lymphadenitis, and its clinical application with FNAC could reduce the necessity for open biopsy.     

Dual infection with atypical mycobacteria and Mycobacterium tuberculosis causing cervical lymphadenopathy in a child

The most common presentation of mycobacterial infection encountered in otolaryngological practice is cervical lymphadenitis. We report a child with an unusual cause of cervical lymphadenopathy, i.e. dual tuberculous infections. This had clinical ramifications as, initially Mycobacterium avium-intracellulare was grown in culture and was resistant to standard anti-tuberculous agents, and hence treated with excision of the lymph node. However, the cultures from the excised lymph node grew out Mycobacterium tuberculosis that was sensitive to standard anti-tuberculous drugs. To our knowledge, no such presentation has been reported previously. We also review the literature on cervical lymphadenitis due to atypical mycobacteria and Mycobacterium tuberculosis, with particular emphasis on clinical presentation, diagnosis and management.     

Tularemia presenting as tonsillopharyngitis and cervical lymphadenitis: a case report and review of the literature

In this report, we describe a 57-year-old woman with oropharyngeal tularemia who presented with tonsillopharyngitis and cervical lymphadenitis. Clinical and radiological manifestations and histopathological characteristics of this disease are discussed with a review of the world literature. The oropharyngeal form of tularemia should be considered in the differential diagnosis of cases involving tonsillopharyngitis and cervical lymphadenitis, particularly in those not responding to penicillin treatment.     

Scrofula revisited

Mycobacterial cervical lymphadenitis, or scrofula, is a disease dating back thousands of years. In spite of modern treatment and public health measures, scrofula persists but is infrequently seen. Five patients with cervical tuberculous lymphadenitis as a sole presentation have been seen in our department in the last 10 years. The clinical presentation and current methods of diagnosis and treatment are described. A short historical review is given.     

Procedure in case of suspected mycobacterial infection of lymph nodes of the neck

Procedure in Case of Suspected Mycobacterial Infection of Lymph Nodes of the Neck. Cervical lymphadenitis of unknown origin is frequently observed in ENT. Besides metastasis, lymphomas and non specific cervical lymphadenitis, tuberculosis or infection with atypical mycobacteria has to be considered. This article tries to present the state of the art procedure in diagnostics to differentiate tuberculosis and atypical mycobacterial infections from other pathologies of cervical lymph nodes.     

Mycobacterial cervical lymphadenitis

Mycobacterial cervical lymphadenitis remains a diagnostic challenge for many clinicians despite current advances in diagnostic laboratory techniques. Although much has been done to prevent tuberculosis, cases of mycobacterial disease in endemic form still occur. Six hundred and forty-five patients with tuberculosis were diagnosed and treated at the American University of Beirut Medical Center during the period from 1970 to 1985. Twenty-nine (4.5%) of these patients had proven mycobacterial cervical lymphadenitis. We stress histopathologic examination as the single most important means for diagnosing mycobacterial cervical lymphadenitis. Operation in combination with antituberculous chemotherapy remain the treatments of choice.     

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。     

Mycobacterial cervical lymphadenitis

Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections. The incidence of mycobacterial cervical lymphadenitis has increased. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis. A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur. A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture. It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Atypical infections can be addressed as local infections and are amenable to surgical therapy.     

Suppurative cervical lymphadenitis in adult: An analysis of predictors for surgical drainage

ObjectiveLymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage.Materials and MethodsWe retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed.ResultsThere were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation.ConclusionsFollowing SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.     

Mycobacterial cervical lymphadenitis: A persistent diagnostic problem

The most common manifestation of mycobacterial infection encountered in otolaryngologic practice is cervical lymphadenitis. Mycobacterial cervical lymphadenitis, or scrofula, remains a diagnostic and therapeutic challenge because it mimics other pathologic processes, and because of the inconsistent reliability of physical and laboratory findings. Twenty-five cases of scrofula were treated at our institution from 1973 to 1986. Positive chest x-ray was exhibited by five (20%) patients. Histologic examination of the excisional biopsy was the most reliable test with 100% positive specimens. This study emphasizes the marked variability in clinical presentation of scrofula and the importance of surgical excisional biopsy for histologic diagnosis.     

Secondary syphilis of the tonsil

Summary An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.     

Kikuchi's disease as the etiology of chronic neck adenopathy

Kikuchi's disease, a rare cause of chronic cervical adenopathy, does not have specific clinical signs. There is a general deterioration in the condition of the patient accompanied by cervical adenopathy. The diagnosis is made histologically by the recognition of histiocytic necrotizing lymphadenitis. The prognosis is usually favorable with spontaneous resolution within a few weeks to a few months.     

组织细胞坏死性淋巴结炎临床分析

目的分析组织细胞坏死性淋巴结炎的临床资料。方法回顾性分析经病理证实的43例组织细胞坏死性淋巴结炎患者的临床特点和治疗过程、预后。结果 43例患者的男女发病率为1：1.15,所有患者均有颈部淋巴结肿大,77%患者伴有发热。20例行糖皮质激素治疗,13例未予药物干预,8例予消炎、止痛等对症治疗,2例手术清扫颈部肿大淋巴结。5例并发感染或自身免疫性疾病,其中2例死亡。随访22例中有5例复发,再次激素治疗有效。结论组织细胞坏死性淋巴结炎的临床表现、实验室和影像检查缺乏特异性,淋巴结活检病理检查可明确诊断。可并发自身免疫性疾病,有必要定期监测免疫功能和随访。     

Management of nontuberculous mycobacterial cervical lymphadenitis

OBJECTIVE: To review the treatment and outcome of patients with nontuberculous mycobacterial (NTM) cervical lymphadenitis. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Thirty consecutive immunocompetent patients (median age, 32 months; age range, 11-147 months) diagnosed as having NTM cervical lymphadenitis over a 77-month period. INTERVENTIONS: Primary therapy for 34 foci of NTM cervical lymphadenitis in 30 children consisted of excisional biopsy (n = 8), incision and drainage procedures (n = 14), fine-needle aspiration biopsy (n = 7), observation only (n = 4), and antimycobacterial chemotherapy only (n = 1). MAIN OUTCOME MEASURES: (1) Time to cure, (2) recurrent adenitis, and (3) complications associated with therapy were determined for each therapeutic option. The average duration of follow-up was 32 months (range, 6-78 months). RESULTS: Nearly all patients (97%) were cured of their disease regardless of which therapeutic option was used. Excisional biopsy, while associated with transient marginal mandibular nerve injury in 1 patient, typically resulted in the most rapid resolution of disease. Observation alone did result in eventual cure, although the disease course was protracted. Simple incision and drainage without curettage was associated with prolonged postoperative wound discharge and hypertrophic scarring. CONCLUSIONS: A variety of therapeutic options were used in children with NTM cervical lymphadenitis. Resolution of infection was an eventual outcome regardless of treatment option, although duration of disease, potential for facial nerve injury, and incidence of hypertrophic scarring varied among the different treatments. An individualized management approach is recommended, with excisional biopsy as the preferred option when feasible.     

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.     

Secondary syphilis of the tonsil

An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.     

Cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in a child: case report

While most cases of cervical lymphadenopathy resolve with conservative management, persistent adenopathy can lead to costly investigations and invasive treatments. One cause of persistent adenopathy, as well as a variety of other associated systemic symptoms, is Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). This rare entity can be diagnosed only by excisional biopsy on the basis of its characteristic histologic appearance. We describe a case of persistent cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in an 11-year-old girl.     

Tuberculosis mimicking Kikuchi's disease

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.