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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure for the diagnosis of mediastinal lymph nodes and masses. Its complications are rare and include hemorrhage, pneumothorax and infections such as mediastinitis. We report the case of a 51-year-old patient who presented with a localized subcarinal adenitis after EBUS-TBNA. Germs colonizing the oropharynx may have been dragged along by the echobronchoscope, inoculating the punctured mediastinal lymph node., (© 2015 S. Karger AG, Basel.)

Objective: To define the cytomorphologic features of toxoplasmic lymphadenitis (TL) and to establish the diagnostic sensitivity and specificity of the cytologic diagnosis., Study Design: A cytohistologic correlation study of 11 patients in which a histologic diagnosis of TL was available. These cases were analyzed in a blind study among other cases of nonneoplastic lymphadenopathies. The results of the study are expressed in terms of diagnostic sensitivity and specificity. Although not included in the study, 3 other cases of TL with serologic confirmation were also reviewed., Results: Microgranulomas were a characteristic finding in TL. They consisted of small clusters of epithelioid histiocytes, each with abundant cytoplasm and an eccentric, oval nucleus. Diff-Quik-stained smears had cytoplasm with particularly pale staining and a homogeneous appearance. Most microgranulomas had a monotonous appearance with a few, small lymphocytes accompanying the epithelioid cells. No necrosis, suppurative changes or giant cells were present. Blind examination by 4 reviewers led to a correct diagnosis of TL in 9 of the 11 cases. Eight of the 9 cases were recognized by each of the 4 reviewers. One false positive diagnosis was made by 1 of the reviewers. The sensitivity of the diagnosis was 72.7-81.8% and the specificity 98.8-100%., Conclusion: This study showed high sensitivity and specificity for the cytologic diagnosis of TL. Given the appropriate clinical context, the presence of characteristic epithelioid microgranulomas permits a diagnosis of TL. The cytologic diagnosis can be easily confirmed with serologic studies, thereby avoiding biopsy.

This report describes the case of a 68-year-old man with bilateral cervical lymphadenitis and chorioretinitis due to bacille Calmette-Guérin (BCG), originating from BCG immunotherapy for treatment of superficial bladder cancer 2 years ago. During antimycobacterial therapy a fistula between the right-sided lymph node and an aneurysm of the carotid artery developed. This led to life-threatening spontaneous bleeding which required vascular graft surgery. Like other known systemic side effects, cervical lymphadenitis may also occur following intravesical BCG immunotherapy, and life-threatening complications cannot be excluded despite adequate medical treatment., (Copyright 2001 S. Karger AG, Basel)

The safety of the vaccine could be assessed by three different investigations: a) During the dose finding study (part I) the vaccine showed good safety in all concentrations employed concerning reactions at the site of injection; palpable lymph node enlargement was common. There was one case of suppurative lymphadenitis amond the 262 children who were given the vaccine in the highest concentration (25 X 10(4) VU). b) Subsequent trials in the course of 21 months, when high risk persons could be vaccinated, revealed a rate of this complication in the 1:1,000 range, no case was reported among older persons. c) After the official approval of the vaccine (10 - 30 X 10(4) VU/ml) in the FRG 1 supp. lymphadenitis among 5,000 vaccinated newborns can be calculated.

BCG administration is known to be a safe procedure. However of late, with increased immunization activities, a few complications following BCG administration have been noted and reported. 36 cases of BCG complications observed over a 4-year period were analyzed by age and sex distribution and by severity of lesion. The most common forms of lesions seen were localized subcutaneous abscesses and regional lymphoadenitis. More serious forms of complications such as mediastinal involvement, BCG lung infiltration and BCG papillitis occurred less frequently.

Pathological, clinical, epidemiological and immunological aspects of a rare tumor, Kaposi's sarcoma, are briefly discussed. The prevalence of the disease in an African population raises questions about genetic and environmental factors in its carcinogenesis. Immunological data indicate a probable viral origin. The clinical patterns seem to be influenced by alterations of the immune defense mechanisms. Most questions about its biological behaviour remain to be answered yet.

The objective of the study was to establish the incidence of suppurative lymphadenitides in newborns vaccinated with BCG vaccines of different strength and to investigate the postvaccination tuberculin positivity of the children involved in the study. Lyophilized vaccines prepared from the Pasteur strain were used. Altogether 51,000 children were included in the study. One group, consisting of 30,000 newborns was vaccinated with a BCG lot containing 2 X 10(5) viable units (VU) per dose. The other group, consisting of 21,000 newborns, was given a BCG lot containing 0.5 X 10(5) VU per dose. The incidence of suppurative lymphadenitides per 1,000 vaccinated infants was 6.84 and 0.87 in the two groups, respectively. Tuberculin tests were carried out 2 years after the vaccination. Two units of RT-23 tuberculin were used. In 3,821 children vaccinated with the stronger vaccine the rate of tuberculin positivity was found to be 19.8 per cent, while it was 16.4 per cent among 5,035 children who had been given the weaker lot.

Twenty-one patients with pleural effusion and 27 patients with lymphadenitis, both tubercular in origin, were administered isoniazid, rifampicin and ethambutol in a daily single dose for 9 months. 100% response was seen in patients with pleural effusion. In the case of tuberculous lymphadenitis the therapeutic response was unsatisfactory, and complete resolution of lymph nodes was achieved in 16 out of 27 patients only (59%). Drug treatment had to be extended for another 3 months which gave 89% response. In view of our present findings, short-course chemotherapy appears not to be the ideal mode of treatment for tuberculous lymphadenitis. There were no side effects from drug therapy in either group of patients.

In the Federal Republic of Germany a BCG vaccine of strain Copenhagen 1331 is used. This vaccine was delivered with a content of 100,000 to 200,000 viable units per dose. Even in this small range one can see a relationship between spontaneously reported side effects, especially suppurated lymphadenitis in newborns. The lower the dosage the rarer the side effects. A diminution of viable units to a concentration of 100,000 to only 150,000 per dose shows a better compatibility though the conversion rate is still greater than 90%. Relevant side effects in schoolchildren or adults were not registered.

Studies performed up to now in animal and man show that potent BCG strains guarantee a higher protection against tuberculosis than strains with weak virulence. Vaccine prepared from a strong BCG strain may be administered in lower doses, reducing the incidence of suppurative adenitis to a level acceptable by the individual patients and the health authorities.

In 42 fine needle aspirations (FNA), the cytologic findings were interpreted as either suppurative or granulomatous inflammation. The majority of these FNAs were performed in patients with a known history of malignancy in whom recurrent or residual malignancy was suspected clinically. In 13 cases, a specific microbiologic diagnosis was made on the basis of the aspirate, either by cytology or by culture. In the remaining 29 cases, no specific diagnosis was possible. Open biopsies were later performed in 9 of the 29 cases, revealing the presence of actinomycosis of the parotid in one case and of carcinoma of the breast in a second. Five additional patients in whom only inflammation was diagnosed on the aspirate subsequently proved to have tumor at the FNA site. FNA therefore is not absolutely reliable for the exclusion of malignancy and requires correlation with other data and appropriate follow-up. Aspiration did, however, rapidly provide solutions to otherwise confusing clinical problems in the majority of instances.

Nine cases of tuberculosis of the breast were diagnosed by fine needle aspiration (FNA) cytology over a six-month period. All cases presented with a breast lump, three of which clinically simulated carcinoma. FNA cytology showed a picture of suppurating granulomatous mastitis; the diagnosis of tuberculosis was established after the demonstration of acid-fast bacilli in the aspirated material.