1/12. Hodgkin's disease presenting as a parasternal chest wall mass.A 53 year-old Moroccan woman presented with a tender parasternal mass. Computerized tomography showed a mediastinal mass protruding through the sternum. Cytologic examination of fluid collected from the mass repeatedly showed acute inflammation. Tuberculostatics were started. Since patient did not improve on tuberculostatics, a small supraclavicular lymph node was removed. Histologic examination showed Morbus Hodgkin of the nodular sclerosing type. Ultimately, cytologic examination of fluid from the parasternal mass showed atypical cells. Response on chemotherapy was excellent with complete disappearance of the parasternal mass. This is a very unusual extranodal presentation of Hodgkin's disease.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/12. Fine needle aspiration cytology in systemic lupus erythematosus lymphadenopathy. A case report.BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology characterized by inflammation in various organ systems, including lymph nodes, due to the production of antinuclear antibodies. The onset of disease is between ages 13 and 40 years, with a female preponderance. CASE: A 30-year-old female presented with right cervical lymphadenopathy and gave a history of intermittent fever and swollen joints of 2.5 years' duration. The patient was on intermittent corticosteroids. With a suggestion of tuberculous lymphadenitis, the patient underwent fine needle aspiration (FNA). The diagnosis of lupus adenopathy was established by FNA of enlarged right cervical lymph nodes. Smears showed predominantly typical and atypical immunoblasts, plasma cells, occasional Reed-Sternberg-like cells and dispersed hematoxylin bodies. Smears were negative for acid-fast bacilli. CONCLUSION: When SLE patients develop lymphadenopathy, FNA cytology helps differentiate lupus adenopathy from infectious conditions, such as tuberculous adenitis, and from Kikuchi's lymphadenitis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/12. Gastric T-cell lymphoma presenting with epithelioid granulomas mimicking tuberculosis in regional lymph nodes.In patients with malignant lymphomas, a sarcoid reaction is occasionally observed. However, lymphoma-related granulomas with caseous necrosis are rare. We describe such a case of T-cell gastric lymphoma that was difficult to diagnose. A 50-year-old man was referred to our hospital because of abnormal gastric endoscopic findings: hypertrophic folds with narrowing of the gastric lumen and multiple ulcers in the body. Gastric biopsy specimens showed non-specific inflammation. An open biopsy of the enlarged gastric regional lymph nodes was performed. The sections revealed effacement of the normal architecture and replacement by numerous epithelioid granulomas accompanied by Langhan's type giant cells with or without central caseous necrosis, strongly suggesting tuberculosis. However, mycobacteria and other causative organisms were not detected, and an anti-tuberculous regimen was ineffective. Repeat gastric biopsies were performed and, finally, atypical lymphocytes were observed infiltrating the mucosa. The patient was diagnosed with gastric T-cell lymphoma based on the results of immunohistochemical stainings. After chemotherapy, a total gastrectomy was performed. The diagnosis of gastric T-cell lymphoma with a sarcoid reaction was confirmed by histological findings of the sections. Namely, the gastric wall was replaced by atypical lymphocytes showing the phenotype of helper T cells, admixed with epithelioid granulomas with Langhan's type giant cells. Thus, this case suggests that regional lymph nodes in gastric lymphomas may be present as epithelioid granulomas with caseous necrosis, mimicking tuberculosis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/12. Mesenteric panniculitis associated with abdominal tuberculous lymphadenitis: a case report and review of the literature.Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of the mesenteric adipose tissue. The specific aetiology of the disease is previously unknown. A case diagnosed as mesenteric panniculitis is presented. The cause was biopsy-proved abdominal tuberculous lymphadenitis. To our knowledge, mesenteric panniculitis associated with tuberculosis infection has not been reported previously in the literature. Thus, we would like to present the first case and describe CT features of the disease.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
5/12. Hodgkin's lymphoma and tuberculosis coexistence in cervical lymph nodes.We describe the case of a 47-year-old man admitted to the Department of hematology because of fever, enlarged cervical and supraclavicular lymph nodes, hepatosplenomegaly and non-specific lung infiltrations. The histopathological examination of the cervical lymph node revealed Hodgkin's lymphoma (HL) NS type I. Clinical evaluation revealed stage IVB according to Ann Arbor classification and the presence of 5 unfavorable prognostic factors according to the International Prognostic Index. Despite BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), the enlarged lymph nodes, lung infiltrations and fever persisted. Microbiological and serological tests did not lead to the identification of any viral or bacterial pathogens. bronchoscopy showed chronic inflammation and post-tuberculosis (TB) scars in bronchi without acid-fast bacilli in bronchoalveolar lavage (BAL) in culture and polymerase chain reaction (PCR) tests. However, the biopsy of the supraclavicular lymph node revealed multiple, caseating and necrotizing granulomatous lesions with scattered Reed-Sternberg (R-S) cells. The auramin staining presented acid-fast bacilli and allowed the diagnosis of productive and caseating TB coexisting with HL. The 4 tuberculostatics regimen and ABVD chemotherapy (adriamycin, bleomycin, vincristine, dacarbazine) resulted in a complete clinical response after 3 months of treatment. In conclusion, the association between HL and TB must be considered, especially in countries where the latter is endemic. The diagnosis may be difficult due to similarities in the clinical course, laboratory tests and imaging procedures.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/12. Lingual ulcer as the only sign of recurrent mycobacterial infection in an hiv/AIDS-infected patient.The report describes an hiv/AIDS patient seen at a referral center in mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an hiv-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the hiv clinic of the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" in mexico City since 1991 for hiv infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months duration. The histopathological examination showed chronic granulomatous inflammation with giant multinucleated cells, suggestive of mycobacterial infection, and recurrence of TB was considered. rifampin, isoniazide, pyrazinamide, ethambutol and streptomycin were administered. The lingual lesion improved with partial healing at the first week and total remission at 45 days after the beginning of the antituberculous treatment. In June, 2003, the patient began highly active antiretroviral therapy (HAART) that included two NRTIs and one NNRTI. At 7 months of follow-up, the patient remains free of lingual lesions. The particularity of the present case is that the lingual ulcer was the only sign of infection by mycobacteria, suggestive of TB, in an hiv/AIDS patient that probably represented a recurrence of a previous episode.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/12. Tuberculous gluteal abscess coexisting with scrofuloderma and tubercular lymphadenitis.A 23-year-old man presented with diffuse swelling of the left buttock with overlying skin lesions associated with seropurulent discharge. There was no past history of tuberculosis. Routine investigations were normal and smears of the discharge for bacteria, fungi, and AFB were negative. However, culture of skin biopsy showed mycobacterium tuberculosis. skin and lymph node biopsy showed granulomatous inflammation suggestive of tuberculosis. Administration of antitubucular therapy led to complete resolution of the lesions within 12 months.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/12. Tuberculous cervical lymphadenitis: an unusual case.A case is reported of a 52-year-old lady who presented with a swelling of the submental region of unknown aetiology mimicking a dental abscess. Following an excision biopsy of the lesion, the histopathology report revealed a mass of lymph nodes with granulomatous inflammation strongly suggestive of infective aetiology, most probably of mycobacterial (either tuberculosis or non-tuberculous mycobacteria (NTM)) origin. Cervical lymph node enlargement due to NTM remains a diagnostic challenge because of the inconsistent reliability of clinical and laboratory findings. We discuss the significance of caseating granulomatous inflammation in cervical lymphadenitis and provide a brief overview of tuberculosis and a comparison with NTM. CLINICAL RELEVANCE: Dental surgeons can play an important role in the diagnosis and early treatment of many systemic conditions and they should be aware of the signs and symptoms of tuberculosis, as this is now an increasingly common condition, particularly amongst the immigrant population.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
9/12. Tuberculous mesenteric lymphadenitis presenting as pyloric stenosis.A 17-year-old Filipina with a three-year history of intermittent, projectile vomiting and weight loss was admitted. A diagnosis of peptic ulcer disease was made, but she was unresponsive to antiulcer therapy. fever, anorexia, cough, and exposure to tuberculosis were denied. Chest x-ray was normal. On barium swallow, the stomach and duodenal bulb were dilated. Endoscopic antral biopsy showed chronic inflammation. Computed tomography revealed enlarged periportal and peripancreatic lymph nodes and an intrahepatic mass. liver biopsy failed to show any acid-fast bacilli. On laparotomy, the pyloroduodenal area was extrinsically compressed by surrounding lymph nodes, which, on biopsy, contained granulomatous inflammation with caseation necrosis and Langhan's giant cells. Gastrojejunostomy was done and antituberculous drugs were given. pyloric stenosis due to tuberculosis is rare, but it should be considered in patients who come from areas where the disease is endemic. Medical management for such cases may suffice.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
10/12. A case of extra-hepatic portal hypertension caused by periportal tuberculous lymphadenitis.This report describes a case of portal hypertension caused by periportal tuberculous lymphadenitis. There were a few reports of portal hypertension associated with tuberculosis. A 27-year-old man was admitted to the hospital because of recurrent hematemesis for 7 days. There was a history of mediastinal tuberculous lymphadenitis 3 years earlier that was treated with isoniazide, rifampin, ethambutol, and pyrazinamide for 2 years. Clinical evaluation revealed esophageal variceal bleeding and main portal vein obstruction by enlarged periportal lymph nodes. The patient underwent distal splenorenal shunt. Pathologic examination of the excised periportal lymph node revealed chronic granulomatous inflammation with central caseous necrosis. Thereafter the patient took antituberculous medication for 12 months. The patient has not re-bled 3 years since the shunt operation.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
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