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。     

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。     

结核性颈淋巴结炎的手术治疗

报告手术治疗６例结核性颈淋巴结炎，均经病理学检查确诊，结合术后化疗治愈。认为：手术结合化疗是治疗结核性颈淋巴结炎安全有效的手段。对经全面检查未发现原发病杜的颈部单个肿块，应考虑结核可能性，主张及早手术切除活检，避免长期误诊。     

结核性颈淋巴结炎的手术治疗（附6例报告）

报告手术治疗６例结核性颈淋巴结炎，均经病理学检查确诊，结合术后化疗治愈。认为：手术结合化疗是治疗结核性颈淋巴结炎安全有效的手段，对经全面检查未发现原发病灶的颈部单个肿块，应考虑结核可能性，主张及早手术切除活检，避免长期误诊。     

99例颈部肿块的临床分析

目的回顾性分析99例因单纯颈部肿块住院并经病理确诊患者（排除常规甲状腺及涎腺肿物）的临床表现及诊治过程,以提高颈部肿块的诊断准确率,为正确制定手术方案提供经验与依据。方法99例患者中1例经颈部CT血管造影（CTA）确诊为颈动脉体瘤后放弃治疗出院,2例淋巴瘤经活检确诊后转科治疗,其余病例均采用手术切除治疗并经病理切片确诊,其中3例转移癌均行患侧颈廓清术,术后辅助放疗。结果所有手术患者术后均随访0．5—3年,其中3例神经鞘膜瘤患者出现声嘶和脑梗塞并发症;2例甲状舌管囊肿患者复发,再次手术;5例恶性肿瘤患者中1例手术后8个月死亡,余均未见复发或转移。结论颈部肿块病变形式多样,掌握其发病特点和规律,充分完善术前检查,可大大减少误诊,降低手术风险。     

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.     

黏膜下喉癌诊疗分析

目的探讨黏膜下喉癌的诊断治疗,进一步提高临床疗效。方法回顾性分析我院1999～2007年收治的8例黏膜下喉癌的临床资料。结果 8例患者行颈部CT检查发现喉部占位性病变,经喉黏膜下深部组织活检病理确诊后行全喉切除和颈廓清术。结论颈部CT检查和喉黏膜下活检是诊断黏膜下喉癌的重要手段,扩大手术切除范围是疗效的关键。     

29例颈部坏死性筋膜炎临床分析

目的：探讨颈部坏死性筋膜炎的临床特点及治疗经验。方法：29例颈部坏死性筋膜炎患者均经CT检查确诊,其中12例行气管切开并行颈侧切开排脓探查术,另17例仅行颈侧切开排脓探查术,术中颈部脓肿切开引流,术后冲洗换药并进行抗感染治疗。结果：28例患者治愈出院,1例死亡。其中有2例并发颈内静脉血栓,4例并发纵隔感染,后经治疗后痊愈。随访半年无复发病例。结论：颈部坏死性筋膜炎患者确诊后应尽早采取手术探查,行颈部脓肿切开引流治疗,可获得满意疗效,并有助于预防严重并发症。     

咽旁间隙肿瘤(附89例临床分析)

目的总结诊治咽旁间隙肿瘤的经验.方法回顾分析咽旁间隙肿瘤89例.术前为32例患者行针吸活检术,50例行CT检查;全部患者均行手术治疗,经腮腺入路29例,经颈入路45例,经颈-下颌骨外旋入路15例,术后全部标本作病理检查.结果针吸活检32例中27例诊断正确,CT检查50例中46例可准确判断肿瘤的位置;组织学检查良性肿瘤72例(81%),以恶性肿瘤、混合瘤多见37(42%).良性肿瘤术后10例复发(14%),恶性肿瘤12例复发或转移(74%).结论术前针吸活检和CT检查对诊断咽旁肿瘤有意义,经腮腺和经颈部入路是最常用手术进路.     

双侧腮腺嗜酸性淋巴肉芽肿1例

患者,男,30岁,因发现双侧颈部肿块8年入院。2003年发现双侧乳突部肿块,直径约5mm,无发热、肿痛,质地硬,表面无破溃,就诊于当地医院,考虑淋巴结结核,给予异烟肼、利福平抗结核治疗,疗效欠佳。因肿块逐渐增大,2006年3月来我院行双侧乳突肿块切除术。术后病理检查示：     

Management of cervical tuberculous lymphadenitis: evaluation of 6 cases

Unlike other advanced nations, secondary spread of tuberculosis still occurs in Japan. Cervical tuberculous lymphadenitis is still an important disease of the neck, and between 2001 to 2005, we treated 6 patients with cervical tuberculous lymphadenitis. All 6 patients were females, and their ages ranged from 28 to 77 years old (average: 62 years). One patient had received antitubercular chemotherapy for pulmonary tuberculosis 40 years earlier. Two patients had a family history of pulmonary tuberculosis. One patient was an immigrant from Thailand. Three patients underwent open biopsy of the cervical lymph node, and were diagnosed with tuberculosis histologically. The remaining three patients had an abscess, and fine-needle aspiration (FNA) biopsy was performed. The diagnosis of tuberculosis was made by detection of acid-fast bacilli, MTD (Mycobacterium tuberculosis direct test), PCR (polymerase chain reaction), and culture. All six patients were treated with antitubercular chemotherapy for 6-9 months and recovered. MTD and PCR of the FNA sample seemed to enable early treatment. Attention needs to be paid to countries around Japan where tuberculosis is spreading. We suggest that treatment should be performed while at the same time making an effort to grasp the trend of spread in other countries as well as Japan.     

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.     

Indispensability of mediastinoscopy in intrathoracic tuberculosis.

An analysis of 33 patients with histologically confirmed intrathoracic tuberculous lymphadenopathy was made. Tuberculosis could have been diagnosed without mediastinoscopy only in 3 patients: 2 had positive bronchial cultures and 1 simultaneous cervical lymph node tuberculosis. Bacteriological confirmation is conclusive, but seldom possible. Mediastinoscopy provides the best method to obtain tissue samples, and consequently, it is still necessary in the diagnosis of intrathoracic 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.     

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.     

A case of follicular carcinoma of thyroid gland with concurrent tuberculous lymphadenitises

We report a case of follicular carcinoma of the thyroid gland with concurrent tuberculous lymphadenitises as neck lymph node metastases of thyroid carcinoma. A 71-year-old woman presented with multiple painless masses in the thyroid gland and painless lymphadenopathies in the right neck. She and her family had no previous history of tuberculosis. A diagnosis of thyroid cancer with lymph node metastases was made, and the patient underwent total thyroidectomy with neck dissection. Lymph nodes were hard and severely adhered to the internal jugular vein. The histopathological diagnosis was follicular carcinoma and multiple nodes of adenomatous goiter of the thyroid gland, and tuberculous lymphadenitises of lymph nodes in the right neck. There was no findings of coexisting pulmonary tuberculosis. The possibility of coexisting tuberculous lymphadenitis must thus be ruled out when we find painless lymph node swelling in aged patients with head and neck cancer including thyroid cancer.     

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.     

Kikuchi-Fujimoto's syndrome masquerading as tuberculosis.

We report a case of a 27-year-old Asian man presenting with the typical features of tuberculous cervical lymphadenitis who was commenced on anti-tuberculous therapy on the strength of the clinical presentation. Histological examination of an excised cervical lymph node however, revealed the diagnosis of Kikuchi's syndrome; a histiocytic necrotizing lymphadenitis which is usually self-limiting.