中老年血管免疫母细胞性T细胞淋巴瘤患者临床特征及预后影响因素分析

目的 探讨中老年血管免疫母细胞性T细胞淋巴瘤(AITL)患者的临床特征、诊断及治疗.方法 回顾性分析,纳入北京医院2008年5月至2017年3月收治的45岁及以上(年龄47?85岁)中老年AITL患者33例,中位年龄64岁,男性54.5％(18例).收集临床表现、病理、影像及生存资料,分析不同治疗方案的客观有效率(OR...     

细针吸取细胞学在HIV感染者体表肿大淋巴结和肿块诊断中的应用

目的 探讨细针吸取细胞学(fine needle aspiration cytology,FNA)对HIV感染者体表肿大淋巴结和肿块诊断的应用价值.方法 采用"友谊式"细针穿刺器,对72例HIV感染者进行FNA检查.获得组织用于制备涂片或细胞块,进行HE染色、抗酸染色、六胺银染色、PAS染色,特殊病例进行细菌培养、免疫组织化学染色和PCR检测.结果 在72例HIV感染者中,穿刺淋巴结65例(90.3%)和体表肿物7例(9.7%).淋巴结病例包括:结核30例(42%),非结核分支杆菌感染5例(7%)、HIV相关性反应性增生14例(19%)、淋巴瘤7例(10%)、化脓性淋巴结炎5例(7%)、隐球菌感染2例(3%)和马尔尼菲青霉菌感染2例(3%).体表肿块包括:皮肤及软组织4例(5.6%)、乳腺2例(2.8%)和甲状腺1例(1.4%),其中恶性肿瘤2例,分别为乳腺淋巴瘤和甲状腺乳头状癌.诊断后多数感染治疗有效.结论 对于HIV感染者进行FNA操作安全、容易执行,诊断可靠、用时较短.取材充分即能够明确多数淋巴结肿大和体表肿块的病因.在本组研究中患者年龄多是20～40岁的男性,结核感染是淋巴结肿大最常见的病因,高级别的恶性淋巴瘤是最多见的恶性肿瘤.     

COVID-19 vaccine-induced lymphadenopathies: incidence,course and imaging features from an ultrasound prospective study

Aimslymphadenopathy can occur after COVID-19 vaccination and when encountered at ultrasound examinations performed for other reasons might pose a diagnostic challenge. Purpose of the study was to evaluate the incidence, course and ultrasound imaging features of vaccine-induced lymphadenopathy.Methods89 healthy volunteers (median age 30, 76 females) were prospectively enrolled. Vaccine-related clinical side effects (e.g., fever, fatigue, palpable or painful lymphadenopathy) were recorded. Participants underwent bilateral axillary, supraclavicular and cervical lymph node stations ultrasound 1–4 weeks after the second dose and then again after 4–12 weeks in those who showed lymphadenopathy at the first ultrasound. B-mode, color-Doppler assessment, and shear-wave elastography (SWE) evaluation were performed. The correlation between lymphadenopathy and vaccine-related side effects was assessed using the Fisher’s exact test.ResultsPost-vaccine lymphadenopathy were found in 69/89 (78%) participants (37 single and 32 multiple lymphadenopathy). Among them, 60 presented vaccine-related side effects, but no statistically significant difference was observed between post-vaccine side effect and lymphadenopathy. Ultrasound features of vaccine-related lymphadenopathy consisted of absence of fatty hilum, round shape and diffuse or asymmetric cortical thickness (median cortical thickness of 5 mm). Vascular signal was mainly found to be increased, localized in both central and peripheral regions. SWE showed a soft cortical consistence in all cases (median value 11 Kpa). At follow-up, lymph-node morphology was completely restored in most cases (54/69, 78%) and in no case lymphadenopathy had worsened.ConclusionA high incidence of vaccine-induced lymphadenopathy was found in a population of healthy subjects, with nearly complete regression within 4–12 weeks.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40477-022-00674-3.     

Nontuberculous mycobacterial infection with concurrent IgG4‐related lymphadenopathy

Disseminated nontuberculous mycobacteria (NTM) infection with concurrent IgG4‐related lymphadenopathy has not been reported. We described a patient with neutralizing autoantibodies to interferon‐gamma (IFN‐γ) and elevated levels of serum IgG4 presenting with generalized lymphadenopathy and reactive dermatosis. Histologically, lymph nodes (LNs) showed effaced nodal architecture with polymorphic infiltrates, mimicking angioimmunoblastic T‐cell lymphoma. Both the absolute number and the ratio of IgG4+ plasma cells to IgG+ plasma cells were increased. Mycobacterium abscessus was isolated from cultures of LNs, and demonstrated by polymerase chain reaction‐restriction fragment length polymorphism. The skin biopsy showed neutrophilic dermatosis, consistent with Sweet syndrome. The patient met the criteria of both adult‐onset immunodeficiency syndrome and IgG4‐related lymphadenopathy. This case provides evidence of disseminated NTM infection with concurrent type III IgG4‐related lymphadenopathy in the patient with anti‐IFN‐γ autoantibodies.     

Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome

BACKGROUND.

The most common presenting site of extracutaneous disease in mycosis fungoides and Sezary syndrome is the peripheral lymph node. Although fine‐needle aspiration biopsy has been shown to be a valuable diagnostic technique in evaluating lymphadenopathy, its utility in patients with cutaneous T‐cell lymphoma has not been extensively studied. With fine‐needle aspiration biopsy, material can be collected for ancillary diagnostic studies and for morphologic evaluation.

METHODS.

The authors report a series of 11 fine‐needle aspiration biopsy specimens from 10 mycosis fungoides and Sezary syndrome patients. Flow cytometric immunophenotyping and T‐cell receptor gamma chain polymerase chain reaction were performed on fine‐needle aspiration biopsy material and correlated with cytologic findings.

RESULTS.

Seven of 10 patients had lymph node involvement by cutaneous T‐cell lymphoma, with 3 cases exhibiting large‐cell transformation and 4 cases exhibiting a small‐cell pattern. Flow cytometric immunophenotyping identified an abnormal T‐cell population in 6 cases. A clonal T‐cell rearrangement by T‐cell receptor gamma chain polymerase chain reaction (TCR‐γ PCR) was identified in 1case in which insufficient events were present for evaluation by flow cytometry and in 1 case in which flow cytometry was not diagnostic of T‐cell lymphoma. Two cases showed involvement by classic Hodgkin lymphoma diagnosed by immunohistochemistry on cell block material.

CONCLUSIONS.

Fine‐needle aspiration biopsy in conjunction with immunophenotyping and T‐cell receptor gamma chain polymerase chain reaction is significantly useful in evaluation of lymphadenopathy in patients with mycosis fungoides and Sezary syndrome, especially for triaging lymph nodes that would otherwise not be sampled or for evaluating multiple lymph nodes. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.     

Sulfasalazine-induced Angioimmunoblastic lymphadenopathy developing in a patient with juvenile chronic arthritis

We describe a patient with juvenile chronic arthritis who developed reactive angioimmunoblastic lymphadenopathy, induced by sulfasalazine. Development of angioimmunoblastic lymphadenopathy although rare, is a very serious side effect of sulfasalazine treatment, and patients treated with this drug should be watched carefully. Received: 10 April 2000 / Accepted: 16 June 2000     

Sinus Histiocytosis with Massive Lymphadenopathy: A Spectrum of Disease Associated with Immune Dysfunction

A detailed immunologic study of three cases of sinus histiocytosis with massive lymphadenopathy (SHML) was performed to better characterize this rare disorder. One patient had prominent cervical lymphadenopathy that regressed spontaneously, whereas the other two patients had persistent cervical lymphadenopathy and recurrent infections. The first patient was otherwise healthy and had normal immunologic studies. One of the latter patients had a relative increase in blood B cells, a decreased level of serum immunoglobulin A (IgA), decreased blood lymphocyte mitogenic responses to multiple mitogens (37-42% of controls), and cutaneous anergy. The other patient with persistent disease also had a relative increase in blood B cells, polyclonal hypergammaglobulinemia, and circulating immune complexes, as well as decreased blood T cells and markedly decreased blood lymphocyte responses to mitogens (12-37% of controls). Immunohistochemical stains of the lymph nodes of the three patients revealed a characteristic phenotype for the sinus histiocytes: S-100 protein, 3/3; CD14 (Leu M3), 3/3; CD11c (Leu M5), 1/1; CD71 (OKT9), 3/3; CD4 (Leu 3a), 2/3; CD1a (OKT6), 1/3; alpha-1-antitrypsin, 3/3; alpha-1-antichymotrypsin, 3/3; CD35 (C3b), 1/1; CD11b (Mo1), 0/3; CD15 (Leu M1), 0/3; HLA-DR, 0/3; and lysozyme, 0/3. This phenotype suggests that the cells of SHML have features of both the Langerhans/interdigitating cell and mononuclear phagocyte lineages. Emperipolesis by the histiocytes of B cells, T cells, and natural killer cells was demonstrated by a double-staining technique. Our findings indicate that patients with SHML may have a variably expressed immunodeficiency that predisposes them to recurrent infections.     

IMMUNOBLASTICLYMPHADENOPATHY－LIKE T－CELLL YMPHOMA：A CLINICOPATHOLOGIC AND IMMUNOPHENOTYPIC ANALYSIS OF 24 CASES

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Fine-needle aspiration cytology in lesions related to ornamental body procedures (skin tattooing,intraoral piercing) and recreational use of drugs (intranasal route)

Body adornment through tattooing and body piercing and the use of recreational drugs are on the increase, producing a variety of secondary lesions, the etiology of which often remains undetected, as the medical community is not yet aware of the extent of the morbidity of such procedures and practices. Three cases are presented, which underscore the problem and also the role that fine-needle aspiration (FNA) can play in clarifying the etiology of such lesions. Two of these cases were lymphadenopathies, one secondary to tattooing and the other to tongue piercing, while the third was a deep intranasal lesion, which in all probability had resulted from intranasal use of recreational drugs. Although the clinical diagnosis of these lesions was problematic, the FNA performed by a pathologist, by associating the cytologic findings with the corresponding clinical setting, was quite indicative of their relation to the aforementioned procedures or practices.