Akute Toxoplasmose bei koexistentem Non-Hodgkin-Lymphom

There are many reasons for cervical lymph node enlargement. In particular, the large group of infectious diseases must be considered along with malignant diseases. The coexistence of an uncommon infectious disease with malignant disease is a rare event. We report the case of an otherwise healthy 69-year-old man with marked enlargement of his cervical lymph nodes. A diagnosis of a recent toxoplasmosis infection was made based on positive IgG and IgM toxoplasma titers and the results of fine-needle aspiration from a lymph node. Since the enlarged lymph nodes persisted for more than weeks, the lymph node was excised. Histological examination revealed a non-Hodgkin's lymphoma. IgM titers in toxoplasmosis can persist up to 1 year. In cases with rare infectious diseases like toxoplasmosis in immunocompromised patients, swollen lymph nodes that persist or grow should lead to the suspicion of additional disease. A diagnosis can be confirmed by removing a lymph node for histology.     

Rosai-Dorfman syndrome. On the differential diagnosis of lymph node swelling]

The Rosai-Dorfman syndrome is a benign disease, one of its commonest affected sites being the cervical lymph nodes. This disease should be considered in the differential diagnosis of a cervical lymphadenopathy. The syndrome often begins with a chronic rhinitis, and is accompanied by sinusitis, tonsillitis or pharyngitis; blood tests indicate chronic infection. The pathogenesis of the disease is still unknown but may include infection or an abnormal autoimmune reaction. The diagnosis is established by the findings of characteristic histiocytes with haemophagocytosis. We report a female patient with persistent cervical lymph node swelling resistant to treatment. The cause was proved by histology to be a Rosai-Dorfman syndrome.     

Kikuchi-Fujimoto disease: a report of 3 cases

Cervical lymphadenopathy has many underlying etiologies. One of its rare causes is Kikuchi-Fujimoto disease (Kikuchi's disease, histiocytic necrotizing lymphadenitis). We discovered such a cause in a 37-year-old woman who had presented with malaise, night sweats, and weight loss in addition to cervical lymphadenopathy. We based our diagnosis on excisional lymph node biopsy. We also review 2 other cases of Kikuchi's disease that were diagnosed by others at our institution. Clinically and histologically, Kikuchi's disease is very similar to lymphoma, and distinguishing the two is difficult. However, despite the fact that Kikuchi's disease is benign, an accurate diagnosis is important because misdiagnosis might lead to unnecessary surgery and/or chemotherapy.     

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.     

Necrotizing lymphadenitis (Kikuchi-Fujimoto disease) as a rare cause of cervical lymphadenopathies. Diagnosis and differential diagnosis

BACKGROUND: The ENT specialist is often confronted with the inquiry as to the cause of lymph node enlargements. Common causes include inflammations, neoplastic, or autoimmune diseases. We report on three cases of Kikuchi-Fujimoto disease as a benign self-limiting lymphadenopathy of unknown etiology, which is usually found in young women between 20 and 30 years of age. Main symptoms are indolent or light tender, enlarged lymph nodes in the neck area. The correct diagnosis requires the histologic examination of the lymph node. Even for the experienced pathologist the differential diagnosis of malignant systemic disorders can be difficult. PATIENTS: Three female patients suffering from Kikuchi-Fujimoto disease were treated in our department between September 1997 and March 1998. RESULTS: All patients showed indolent and enlarged lymph nodes in the neck. In one case we were able to diagnose an acute cytomegalovirus infection; in another case an acute Epstein-Barr virus infection. After 3-5 months the symptoms disappeared spontaneously in all patients. In two of the three cases, histologic lymph node examination revealed T-cell lymphoma and Hodgkin's disease and in one case led to initial chemotherapeutic treatment. As a result of a second histologic examination, both diagnoses were reviewed and Kikuchi-Fujimoto disease was diagnosed. Chemotherapy was discontinued. CONCLUSIONS: Kikuchi-Fujimoto disease is a benign, self-limiting lymphadenopathy which is usually diagnosed in young women. Distinguishing Kikuchi-Fujimoto disease from malignant systemic disorders may even be difficult for pathologists using histological examination techniques and requires close cooperation between the ENT specialist and the pathologist. In order to minimize the risk of misdiagnosis and incorrect treatment, the ENT specialist should inform the pathologist about the differential diagnosis of Kikuchi-Fujimoto disease in such cases.     

Acute ENT admission in Kawasaki disease

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis of childhood carrying a 1-2 per cent mortality from cardiovascular complications. Despite the extensive literature on Kawasaki disease in paediatric journals, there has been a paucity of documentation in the otolaryngology literature. This is despite the fact that Kawasaki disease may present as an otolaryngological emergency before the diagnosis is established. We describe three cases of Kawasaki disease, all of which presented to the ENT department of this hospital within a period of two months. These cases illustrate the slow evolution characteristic of the disease and highlight the difficulties of diagnosis in the initial febrile stage. We emphasize the importance of considering the diagnosis when treating a young child with a pyrexia resistant to antibiotics, as prompt introduction of therapy may decrease the risk of fatal coronary artery or cardiac involvement.     

Cervical manifestation of blastomycosis

Blastomycosis is a common systemic fungal infection in which the physical and radiographic findings appear far more serious than the subjective signs and symptoms. Although blastomycosis of the head and neck is often difficult to diagnose, clues in the patient's history and a few laboratory tests can establish the diagnosis. Involvement of the skin and soft tissues provides an unusual opportunity for direct access to the organism for culture and pathologic diagnosis. We present a case of blastomycosis presenting in a single abscessed cervical lymph node. The diagnosis was established by fine-needle aspiration of the cervical mass. The primary lung disease was confirmed by chest radiography and computed tomography. The clinical and pathologic features of the disease are discussed. [Editorial comment: Pulmonary blastomycosis may present with cervical adenopathy. This article demonstrates the potential value of fine needle aspiration in establishing this diagnosis.]     

颈部巨淋巴结增生临床分析

目的 提高对颈部巨淋巴结增生(Castleman病)的诊断水平.方法 回顾性分析曾经误诊的10例巨淋巴结增生的临床资料,分析临床诊断和鉴别诊断的经验和教训.结果 10例颈部巨淋巴结增生患者,男3例,女7例;按Frizzera分类标准分为局灶性8例(其中透明血管型6例,混合型2例),多中心性2例(其中浆细胞型1例,混合型1例).临床以无痛性颈淋巴结肿大为特征,多中心性2例伴有全身症状和(或)多脏器受累等特征.10例患者均为误诊后接受淋巴结切除术后病理检查确诊.随访4～17年10例患者均健康生存,其中1例多中心性浆细胞型患者术后2年复发,再次接受淋巴结手术切除术和化疗后4年未再复发.结论 颈部巨淋巴结增生临床少见,易于误诊,应采用淋巴结切除活检术病理检查确定诊断,注意与颈淋巴结结核、颈淋巴结炎、结节病、肉芽肿等鉴别.如无系统功能严重受累,首选手术切除.     

Tularemia in the differential diagnosis of cervical lymph node enlargement. An outbreak of tularemia in Castilla-León, Spain

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region.     

A case of cervical progressive transformation of germinal center

Progressive transformation of the germinal center is an unexplained borderline disease that presents as lymphadenopathy. The histological feature is an abnormally enlarged germinal center. Reports of this disease in otolaryngology are rare. A case of progressive transformation of the germinal center occurring in the bilateral multiple submandibular lymph nodes with swelling is presented. A 41-year-old man complained of bilateral painless cervical lymphadenopathy. Because fine needle cytology of the lymph nodes did not reveal any atypical cells, medical observation was performed. However, as the patient suffered from hoarseness, he consulted our hospital again. An otolaryngeal examination revealed mild enlarged bilateral lymphadenopathy. Removal of these lymph nodes to obtain a definitive diagnosis was performed. The pathological diagnosis was progressive transformation of the germinal center (PTGC). Immunostaining of the lymph nodes showed increased IgG4+cells (IgG4/IgG ratio=50%). To date, no significant changes in the cervical lymph nodes have been noted on follow-up. Because PTGC is apt to be misdiagnosed as Hodgkin's lymphoma, otolaryngologists should have full knowledge of PTGC.     

Pediatric Kikuchi-Fujimoto disease masquerading as a submandibular gland tumor

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare disorder that typically affects the cervical lymph nodes. The disease usually occurs in women in their late 20s or early 30s. Reports in the pediatric literature are sparse. Most authors consider Kikuchi-Fujimoto disease as a self-limiting disorder that requires no specific management but long-term follow-up. The clinical features of Kikuchi-Fujimoto disease are easily confused with other less-benign conditions. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigations. We describe a case of Kikuchi-Fujimoto disease in an 8-year-old boy which presenting as a submandibular gland tumor. The case illustrates the clinical features of this unusual condition and emphasizes the potential confusion with other diagnoses.     

Lymphknotensarkoidose der Submandibularisloge

Sarcoidosis is a granulomatous systemic disease of unknown etiology. Besides the landmark pulmonary lesions, extrathoracic manifestations of the disease can also occur. We report the case of a 53-year-old woman with an obscure swelling of both submandibular compartments. The radiological and pathohistological evaluations confirmed the uncommon diagnosis of sarcoidosis of the submandibular compartment. The tumor in each compartment consisted of a huge lymph node conglomerate respectively displacing the submandibular gland. The major salivary glands and the thorax were not involved.     

Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998

OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.     

Parotid mass as an early sign of Kaposi's sarcoma associated with human herpesvirus 8 infection

Kaposi's sarcoma of an intraparotid lymph node is extremely rare in non-immunocompromised human immuno-1 deficiency virus (HIV)-negative patients. We report a case of a left parotid mass as an early sign of Kaposi's sarcoma-associated human herpesvirus 8 (HHV-8) infection in a 57-year-old patient. After subtotal parotidectomy and histopathological diagnosis of lymph node localization of Kaposi's sarcoma, an accurate dermatological investigation revealed a solitary small lesion in the left foot. Chemotherapy with five cycles of vincristine gave a temporary response of the cutaneous lesion. Seven months later, a few small, firm, purplish-red lesions appeared in different areas of the body, but no adjuvant treatment was accepted by the patient since the lesions occasionally disappeared or remained stable in size. At four years follow-up, there has been no recurrence in the parotid region, and the patient is alive with cutaneous disease but in good general health. The problems related to the diagnosis, the management strategy of such a rare condition and the prognosis are also discussed.     

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): a rare case of subglottic narrowing.

A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in an eight-year-old child with Rosai-Dorfman disease is presented. The airway obstruction was initially managed with a tracheostomy, and then on confirmation of the diagnosis by lymph node biopsy, by excision of the extranodal deposit with a CO2 bronchoscopic laser.     

Manifestation of malignant lymphoma of the head and neck with special reference to the salivary glands

We found that thirteen per cent of all head and neck malignomas are malignant lymphomas. In 75% of these cases the Non-Hodgkin type could be found. The major salivary glands were involved by the lymphoma in 55% out of 104 patients. Paraglandular lymph nodes of the parotid gland were affected as well as intraglandular lymph nodes and the lymphoid tissue within the gland proper. The submandibular gland normally shows an involvement only with its paraglandular lymph nodes. Two thirds of the Non-Hodgkin lymphomas located in the salivary glands were low-grade. In case of clinical suspicion of a malignant lymphoma, fine needle biopsy is required for cytological diagnosis. However, surgery is mandatory for histological diagnosis, not as a therapeutic measure.     

Acquired immune deficiency syndrome--related lymphadenopathies presenting in the salivary gland lymph nodes

Homosexual males at risk for acquired immune deficiency syndrome (AIDS) frequently present with peripheral lymphadenopathies that precede the opportunistic infections and neoplasias of this disease. Two homosexual males had enlarged salivary glands due to lymphadenopathies initially affecting intraparotid and perisubmaxillary gland lymph nodes. Both the hyperplastic and the atrophic histologic patterns of AIDS-related lymphadenopathies were observed in the lymph nodes. Subsequently, the two patients developed lymphoma and opportunistic infections, respectively. The AIDS-related lymphadenopathy developing in salivary gland lymph nodes is an entity that should be considered in the differential diagnosis of salivary gland tumors.     

Cutaneous form of sarcoidosis at the auricle

Sarkoidosis is a disease of so far unknown etiology that can affect potentially every organ. Sarcoidosis of the lung is the most common form, nevertheless in more than one third of the cases the head and neck area is affected. Manifestations of the disease can be present in lymph nodes of the neck, the middle ear, the pars petrosa of the temporal bone and in the paranasal sinuses as well as in the larynx and pharynx. We would like to present two rare manifestations of sarkoidosis of the ear lobe. The cutaneous form of sarcoidosis is characterized by a spectrum of skin changes. Aside from the physical presentation and observation of the disease progress the diagnosis is confirmed histologically. A multidisciplinary care of the affected patients is needed to diagnose the systemic extend of the disease on one side and to provide the patient with an effective therapeutic regimen that includes surgical and conservative measures on the other.     

Castleman’s disease (giant lymph node hyperplasia) of the neck: a case report

Castleman’s disease (giant lymph node hyperplasia) is an uncommon cause of neck mass. Its cause and pathogenesis are still unknown. Giant lymph node hyperplasia (GLH) usually presents as an asymptomatic solitary mass and can occur anywhere in the head and neck. Diagnostic test results are always inconclusive. Excision and histopathological evaluation are the only ways to make a definitive diagnosis. The disease is curable by surgical excision. A case of GLH presenting as a solitary neck mass in a 68-year-old man is reported. There has been no recurrence during about 7 months. Received: 25 May 1999 / Accepted: 7 September 2000     

Mucocutaneous lymph node syndrome mimicking acute coalescent mastoiditis

Mucocutaneous lymph node syndrome (Kawasaki's disease) is an acute febrile, exanthomatous illness in which massive lymphadenopathy may occur in the cervical area. This lymphadenopathy may mimic other conditions and present a diagnostic dilemma. We present a case report of a child whose initial clinical signs, symptoms, and laboratory findings were compatible with acute coalescent mastoiditis; however, the child was found after close observation to have Kawasaki's disease. The case demonstrates the similarity between the two diseases and how close observation can prevent unnecessary surgery. When considering the rare diagnosis of mastoiditis, other entities need to be considered in the differential diagnosis before surgical intervention is undertaken. If the patient is unstable or a threatened complication of mastoiditis is apparent, however, immediate mastoidectomy is required.