1/15. Demonstration of parasites in toxoplasma lymphadenitis by fine-needle aspiration cytology: report of two cases.Two cases of toxoplasma lymphadenitis diagnosed by fine-needle aspiration (FNA) cytology, in which the microorganisms were identified in the cytologic preparations, are presented. The first case was that of an 8-yr-old boy with bilateral cervical lymphadenopathy of 2-mo duration, in which an FNA specimen of one of the lymph nodes in a Papanicolaou-stained smear disclosed a toxoplasma cyst, and in Wright-Giemsa preparation, dispersed tachyzoites and a pseudocyst. The second case was that of a 52-yr-old man with enlargement of a single lymph node in the neck, of 3-mo duration, FNA of which in Wright-Giemsa preparation disclosed numerous tachyzoites dispersed free in exudate, and also within cells, forming pseudocysts. In both cases, immunocytochemistry by the peroxidase method for toxoplasma gondii antigen was positive. The tachyzoites seen in Wright-Giemsa preparations, when subjected to fluorescence microscopy, emitted autofluorescence, facilitating their identification. While the presence of parasites in toxoplasma lymphadenitis is quite unusual, having been reported occasionally in histologic preparations and only rarely in cytologic FNA materials, our 2 cases suggest that in active disease, tachyzoites may not be so uncommon in FNA specimens. Besides the use of immunocytochemistry in the diagnosis of the disease, air-dried preparations stained by the Wright-Giemsa method are valuable for the demonstration of such parasites through careful search, along with the possible use of fluorescence microscopy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/15. Acute viral lymphadenitis mimicking low-grade peripheral T-cell lymphoma. A clinicopathological study of nine cases.Acute viral lymphadenitis, especially infectious mononucleosis (IM), often shows the presence of Reed-Sternberg-like cells, resulting in confusion with Hodgkin's disease. However, acute viral lymphadenitis requiring differential diagnosis from non-Hodgkin's lymphoma is not widely recognized. We describe the clinicopathological and immunohistochemical features of lymph node lesions from nine such patients which pose serious problems of differential diagnosis from low-grade peripheral T-cell lymphoma. There were three males and six females with ages ranging from 21 to 44 years (median 25 years). All patients had "B" symptoms and multicentric lymphadenopathy. The clinical course was also self-limiting. Each lymph node specimen showed an obvious expansion of an interfollicular area by pleomorphic and polymorphous infiltration with an increased number of arborizing postcapillary venules. The infiltrate was composed of variable numbers of small and medium-sized lymphocytes, immunoblasts, plasma cells in various stage of maturation and occasional granulocytes. The small lymphocytes usually had regular round nuclei, whereas the medium-sized lymphocytes occasionally showed nuclear pleomorphism. Hyperreactivity of b-lymphocytes, including hyperplastic germinal centers and/or foci of monocytoid B-cells, was seen in parts of the lesion. The majority of the interfollicular t-lymphocytes, including T-immunoblasts, expressed CD8 antigen. Various numbers of TIA-1-positive small and medium-sized T-cells were observed in the paracortical area. Despite these findings, the overall histological picture of this series posed serious difficulties when differentially diagnosing this condition from low-grade peripheral T-cell lymphomas such as angioimmunoblastic T-cell (AILD) and T-zone types, indicating that viral lymphadenitis occasionally presents with histological features of AILD and T-zone lymphomas. To avoid overdiagnosis and overtreatment, we emphasize the need to pay careful attention to the clinical and laboratory findings as well as the morphological features.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/15. diagnosis, management and surgical treatment of non-tuberculous mycobacterial head and neck infection in children.The aim of this study was to present our experience with the clinical characteristics of non-tuberculous mycobacterial (NTM) head and neck lymph node infections, the use of modern diagnostic tools and the appropriate therapeutic measures. We have reviewed the cases of 14 Caucasian children with NTM head and neck lymphadenitis who were treated in our clinic in the last 5 years. Three of the patients were male and 11 were female. Their age ranged from 15 to 98 months (mean age 45.7 /- 21.76 months). Cervical lymph nodes were involved in all of our cases, while the submandibular region was found to be the area mostly affected. Overlying skin was involved in 7 cases. diagnosis was based on intradermal skin testing with specific antigens for atypical mycobacteria, histological examination and specimen culture. skin tests were positive for NTM in all of the patients with a predilection for mycobacterium avium complex. The diagnosis was confirmed by histological examination in 13 cases. Specimen culture was positive in 9 cases, most of them growing M. avium-intracellulare complex. Treatment included complete surgical excision of the affected lymph nodes and the overlying skin, as well as functional neck dissection when required. A second procedure was performed in 2 patients. Successful evaluation of NTM infections of the head and neck lymph nodes should include a detailed history, thorough physical examination and specific laboratory investigations. The treatment of choice is complete surgical excision of all affected tissue.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/15. Sinus histiocytosis with massive lymphadenopathy: fifteen new cases.Fifteen cases of chronic lymphadenitis with massive hemophagocytic sinus histiocytosis were analyzed. Fourteen patients were whites, 13 were Europeans, and 11 were males; 10 patients were under 10, 4 were over 20, and 2 over 60 years old. The oldest patient died; all other either healed without therapy or are in excellent condition. We studied the cytologic features of lymph node imprints. A 5-year-old girl was examined more thoroughly. High antibody titers to klebsiella antigens were found repeatedly. The patient also had a constant lymphocytopenia. Phytohemagglutinin-induced blast transformation and lymphotoxin production were within normal limits. No serum Epstein-Barr virus-antibodies could be detected.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/15. An adult case of severe chronic active Epstein-Barr virus infection syndrome.A 23-year-old man with persisting high fever developed hepatosplenomegaly, lymphadenopathy and massive pericardial effusion. Immunological examination revealed a marked elevation of anti-Epstein-Barr virus antibodies (anti-viral capsid antigens IgG-antibody 1:10,240, anti-early antigens-DR IgG-antibody 1:5,120), decreased activities of Epstein-Barr virus specific cytotoxic T lymphocytes, natural killer cells and lymphokine activated killer cells. A liver biopsy showed moderate sinusoidal lymphocytosis with punched-out lesions. These findings suggested severe chronic active Epstein-Barr virus infection syndrome. The patient was treated with recombinant human interleukin-2, but it was discontinued because of an adverse reaction. Twelve months later, he died of suspected pulmonary infection.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
6/15. Restoration of defective cellular immunity by levamisole in a patient with immunoblastic lymphadenopathy.A 71-year-old woman presented with acutely developed symptoms of generalized lymphadenopathy, intermittent maculo-papular skin rash, pruritus, weight loss, hepato-splenomegaly, pleural exsudate and alternating breast swellings. The histopathological picture of biopsies from a lymph node and from the skin was diagnostic for immunoblastic lymphadenopathy, and the serum concentrations of IgG and IgA were increased. Delayed cutaneous hypersensitivity reactions to various antigens were totally extinguished and the number of t-lymphocytes in the peripheral blood was consistently very low. The number of both T- and b-lymphocytes further decreased during cytostatic treatment and the patient contracted numerous infections. During intermittent treatment with levamisole the infectious episodes ceased, the cellular immune response was reestablished and the pathological hyperimmuneglobulinaemia suppressed. It is suggested that the primary immunological defect in this disease could be a failing cellular immunity, and that the hyperplasia and hyper-reactivity of the B-cell system are a secondary phenomenon.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/15. Human herpesvirus-6-associated acute lymphadenitis in immunocompetent adults.In contrast to other causes of herpetic lymphadenitis, the histological features associated with human herpesvirus-6 (HHV-6) infection have remained elusive since its discovery in 1986. We describe the histologic and phenotypic changes associated with acute HHV-6 lymphadenitis in two immunocompetent adults who presented with fever, fatigue, generalized lymphadenopathy, and elevated liver enzymes. serologic tests for human immunodeficiency virus, acute Epstein-Barr virus, and cytomegalovirus infection were negative. Lymph node biopsies were consistent with viral lymphadenitis. Intranuclear and cytoplasmic inclusions were identified in CD4-positive T lymphocytes in expanded paracortical areas. Immunohistochemical staining with monoclonal antibody to the HHV-6 gp60/110 kDa envelope glycoprotein showed that the inclusions were positive for viral antigen. Electron microscopy demonstrated numerous viral particles in the cytoplasm and nucleus, characteristic of herpesviridae family. Clustering of viral particles was observed, which has previously been reported only in infected tissue culture cells. PCR followed by sequencing of dna extracted from the lymph nodes identified the virus as HHV-6, type B. This is the first report that documents distinctive histologic features of HHV-6 lymphadenitis and demonstrates that the cells harboring the virus in vivo are CD4-positive T lymphocytes.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/15. Clonal rearrangement of the T-cell receptor beta-chain gene in hyperplastic lymphadenopathy associated with lung cancer.A patient presenting with marked inflammatory lymphadenitis and Jaccoud's arthritis was found to have a rearranged gene for the beta-chain of the T-cell receptor (TCR-beta) antigen in the lymph node dna digests and normal germ line dna in the peripheral blood lymphocytes. Four months later, the patient was diagnosed to have poorly differentiated adenocarcinoma of the lung with small foci of metastatic tumor in lymph nodes that contained the same extensive lymphocytic and inflammatory cell infiltrates noted earlier. Rearranged TCR-beta chain genes were detected in both lymph node and peripheral blood lymphocyte dna at this time. The most likely explanation for the florid lymph node reaction and the unusual arthropathy appears to be a paraneoplastic immune response. The rearranged TCR-beta genes indicate a clonal T-cell expansion that most likely resulted from the aberrant immunologic response to the lung cancer.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/15. lymphadenitis and lymphoproliferative lesions associated with the human herpes virus-6 (HHV-6).A newly described herpes virus, human herpes virus 6, (HHV-6), has been linked to exanthema subitum but beyond this its pathogenetic impact remains to be determined. A large body of evidence links it to various lymphoproliferative disorders and this study was conducted to identify forms of lymphoproliferation linked to HHV-6. We studied biopsy samples from 32 patients with disorders of the lymphatic system for the presence of HHV-6, both by polymerase chain reaction (PCR) and in-situ hybridization (ISH) methods, as well as Epstein-Barr virus (EBV) viral dna, clonal rearrangements of the antigen receptor genes and bcl-2 genes. All the specimens were studied morphologically and a clinical follow-up of up to 4 years was obtained. Seven of the 32 patients were positive for HHV-6 dna and the remainder were negative. Two of these HHV-6 positive specimens, both from elderly persons, showed a similar distinct histological pattern diagnosed as malignant B-cell lymphoma of high grade malignancy. Two other HHV-6-positive specimens were reactive lymphadenopathies occurring in younger adults. In addition, one further specimen with evidence of EBV-involvement was from a patient who died 3 months after biopsy with fatal infectious mononucleosis (IM). These five samples had HHV-6 dna by PCR and ISH. Two specimens without specific histologic abnormalities showed evidence of HHV-6 only by PCR but not by ISH. Both high grade malignant lymphomas showed clonal proliferations, one of monoclonal B-cells and the other of clonal T-cells.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/15. Localized herpes simplex lymphadenitis: report of three cases and review of the literature.This report describes three cases of localized or regional herpes simplex virus lymphadenitis. Of the two patients who presented with inguinal lymphadenopathy, one had a localized rash prior to the development of lymphadenopathy, and the other developed a genital rash 2 days after lymph node biopsy. The third had occipital lymphadenopathy and concurrent localized occipital herpetic folliculitis. Localized herpes simplex virus lymphadenitis appears to be a specific clinicopathological entity. Histologically, it is characterized by varying degrees of follicular and paracortical hyperplasia, a prominent immunoblastic response and perinodal inflammation. Viral inclusions with or without focal necrosis in the lymph node may be seen, and immunostaining for viral antigen may be seen in paracortical cells.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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