Immunoglobulin G4–Related Lymphadenopathy

Immunoglobulin G4–related lymphadenopathy (IgG4-RLAD) occurs in the setting of extranodal IgG4-related disease (IgG4-RD), an immune-mediated process described in many organ systems characterized by lymphoplasmacytic infiltrates with abundant IgG4-positive plasma cells and fibrosis. Although the morphologic features in the lymph node sometimes resemble those seen at the extranodal sites, 5 microscopic patterns have been described, most of which resemble reactive lymphoid hyperplasia. This morphologic variability leads to unique diagnostic challenges and a broad differential diagnosis. As IgG4-RD may be exquisitely responsive to steroids or other immunotherapy, histologic recognition and inclusion of IgG4-RLAD in the differential diagnosis is vital.     

Rosai–Dorfman disease with exclusive intra-abdominal lymphadenopathy masquerading as Wilkie’s syndrome

Rosai–Dorfman disease is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with nonspecific symptoms and massive cervical lymphadenopathy. Exclusive involvement of intra-abdominal lymph nodes is unusual and presentation mimicking Wilkie’s syndrome due to compression of the third part of the duodenum by enlarged retroduodenal lymph nodes is rare. This entity should be included in the differential diagnosis with infectious, granulomatous and malignant causes of intra-abdominal lymphadenopathy. We highlight an uncommon presentation and discuss the challenges in the diagnosis and management of Rosai–Dorfman disease.     

乙型肝炎患者肝门区淋巴结肿大的超声诊断价值

目的探讨病毒性肝炎(乙型)患者肝门区淋巴结肿大的诊断及临床意义。方法常规超声检查37例住院乙肝患者,被检者肝门区清晰显示肿大淋巴结后,观察并记录肿大淋巴结数目、大小、分布范围及内部血流信号,测量胆囊壁厚度,并摄片保存。结果超声显示淋巴结肿大1个(5例),2个(16例),3个(10例),4个及以上(6例)。淋巴结长径14～30 mm,平均18 mm,位于门脉主干、肝动脉周围及肝胃韧带间,以门脉主干周围多见;淋巴结呈卵圆形,包膜完整,边界清晰,以低回声为主,回声欠均匀,比较孤立,内见少量点状血流信号。结论病毒性肝炎(乙型)可以引起肝门区淋巴结肿大,且与血清肝功能变化及病变程度有一定关系,可作为病毒性肝炎肝外系统声像图改变的又一观察指标。     

Lymphadenopathy by Scrub Typhus Mimicking Metastasis on FDG PET/CT in a Patient with a History of Breast Cancer

We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy.     

肺癌和食管癌淋巴结转移的比较研究

通过肺癌１５２例，食管癌８２例，手术廓清淋巴结１４１２个的区域分布和病理结果的比较分析，显示其共性规律是上位癌向上转移大于向下。上叶肺癌转移路近似于“√”号，下叶肺癌转移路似倒“√”号，上段食管癌其梭形转移圈上长下短，下段食管癌则上短下长。     

不同线束治疗鼻咽癌颈转移淋巴结的远期疗效比较

目的分析比较鼻咽癌颈转移淋巴结应用６０Ｃｏ与６０Ｃｏ加深部ｘ线治疗的远期疗效。材料与方法１９７７年３月～１９８３年１２月共收治３１０例鼻咽癌，其中有颈淋巴结转移２７６例。分两组治疗，单纯６０Ｃｏ治疗１３４例，６０Ｃｏ合并深部ｘ线治疗１４２例。结果５，１０年生存率单纯６０Ｃｏ组为１７．９％、９．７％，６０Ｃｏ加深部ｘ线组为２８．２％，１９％，两组差异有显著意义（Ｐ＜０．０５）；通过对临床分期及Ｎ病期与５，１０年生存率两组的对比分析，Ⅲ期Ｎ２单纯６０Ｃｏ组明显低于混合线束组（Ｐ＜０．０５）。结论　　提示鼻咽癌颈转移淋巴结采用６０Ｃｏ合并深部ｘ线混合线束治疗是有利的，特别是在Ｎ２病人中。     

Clinico-pathological profile of pediatric lymphadenopathy

Objective : To study the clinico-pathological profile of significant pediatric peripheral lymphadenopathy and to arrive at an etiological diagnosis.Methods : Prospective study in a tertiary care hospital setting. One hundred consecutive children reporting to pediatric OPD from 1 January 1995 to 31 December 1998, aged 1 month to 12 years were studied.Results : The commonest aetiology diagnosed was tubercular lymphadenitis in 35% cases, followed by chronic tonsillopharyngitis in 15% cases. Lymphomas, AIDS and infectious mononucleosis constituted 3,2 and 1 cases each. Aetiology could not be ascertained in 44 (44%) children even after detailed haematological, microbiological, radiological and serological investigations. FNAC’s sensitivity and specificity as compared to ’gold standard of excision lymph node biopsy was 94% and 100% respectively.Conclusion : Tubercular lymphadenitis was the commonest treatable entity of significant pediatric peripheral lymphadenopathy. A majority of the cases even after thorough evaluation, remained undiagnosed. FNAC as a diagnostic modality is almost as sensitive and as specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.