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Tuberculous lymphadenopathy without HIV infection, in comparison with those with HIV infection, was characterized by a more favorable clinical course, limited lesion and, especially important, limited caseous-necrotic changes. Analysis of the histological picture of the removed lymph nodes in patients with HIV-i made it possible to distinguish three activities of tuberculous lymphadenopathy: an inactive phase (with a predominance of a productive cellular reaction) - in 3 patients (5.3%), an active (with a predominantly productive-necrotic tissue reaction) - in 11 patients (19.3%), the phase of progression of the pathological process (mainly necrotic lesions, suppuration and formation of fistulas) - in 43 patients (75.4%). It was found that the inactive phase is 5.5 times more common in patients without HIV than in patients with HIV (29.3% and 5.3%, respectively, P˂0.001), while the active phase and the progression phase was 1.5 and 1.3 times more frequent in patients with HIV than in patients without HIV (19.3% and 13.1, respectively, P˃0.5; 75.4% and 57, 6%, respectively, P˂0.02).

Objective: Some cervical tuberculous lymphadenopathy (CTL) presents no evidence of tuberculosis (TB), even after thorough examination of a fine-needle aspiration (FNA) specimen. After the examination of excisional specimens, when the polymerase chain reaction (PCR) analysis identifies the nucleic acid of Mycobacterium tuberculosis (Mtb) or the culture results are positive, then the diagnosis of CTL is established. We refer to this condition as occult CTL (OCTL). Patient and Methods: The present work is a retrospective review of a consecutive series of OCTL cases that were treated at the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, between June 2015 and September 2020. When the diagnosis of OCTL was established, the patients received the standard anti-TB chemotherapy. Results: Fourteen cases of OCTL, including 9 female and 5 male patients, aged 24 to 71 years (median age 42 years), were included in the present study. The most commonly observed levels of lymph node involvement were level V and level II. Each level of the involved lymph nodes was removed entirely through en bloc surgical resection. An evaluation of the excisional specimens led to positive PCR results in all 14 cases, with 2 cases presenting positive culture and 3 cases exhibiting positive acid-fast bacilli (AFB) staining. Recovery was uneventful, and the anti-TB chemotherapy was completed in all cases. The median duration of follow-up was 29 months, during which no case of TB relapse was observed. Conclusions: Wide surgical excision is crucial for the diagnosis and management of OCTL, and when used in combination with anti-TB chemotherapy, it results in satisfactory patient outcomes.

Background: Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. Materials and Methods: Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. Results: Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). Conclusion: EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert.

Background The incidence of tuberculosis (TB) is changing in India. The commonest extra pulmonary manifestation of TB is tuberculous lymphadenitis. Aims and objectives To detect changes in occurrence of TB lymphadenitis by comparing current data with that from 10 years back. Methods Fine Needle Aspiration Cytology (FNAC) findings of patients presenting with lymphadenopathy between January 2014 and December 2015 were included in the study as current data. Cases of TB lymphadenitis were analysed for cyto-morphological patterns and frequency of acid fast bacilli (AFB) positivity. Cytological data of patients with lymphadenopathy between January 2002 and December 2003, were collected from records. Subsequently, comparison was done between previous data and current observation. Results Total 302 cases of lymphadenopathy were included in 2014 and 2015. Tuberculous lymphadenitis accounted for 96 (31.7%) cases, among which AFB was present in 47 (49%) cases. Data collected from registers of the years 2002 and 2003 included 318 cases where tuberculous lymphadenitis accounted for 161 (50.6%) cases and AFB was detected in 101 (63%) patients. Maximum AFB positivity was found in smears with caseous necrosis only. Conclusion Presently occurrence of TB lymphadenopathy has reduced compared to the period of 2002–2003. Despite this declining trend, the disease continues to be one of the leading causes of lymphadenopathy in both periods.

This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis. A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST). Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance. An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance., EBUS-TBNA has value in mediastinal adenopathy, including drug-resistant TB. Combined Xpert MTB/RIF and TB culture testing on EBUS-TBNA specimens helps in diagnosing rifampicin resistance missed by Xpert MTB/RIF. http://bit.ly/2LT2OOD

Background:Tuberculous lymphadenopathy is an extremely common condition in developing countries; however, vocal cord paralysis secondary to compression by enlarged tuberculous lymph node is an extremely rare presentation. Case Presentation:In this paper, we present the case of a 72-year-old male patient who came to us with concerns of hoarseness of voice for the last eight months with fever and chills. He had been treated previously at ear, nose and throat (ENT) clinics and on evaluation, we discovered he had left vocal cord paralysis. Imaging showed multiple enlarged mediastinal and right hilar lymph nodes. Management & Results:Mediastinoscopy with biopsy was done and after histopathologic confirmation of tuberculosis, the patient was prescribed antituberculous treatment. Conclusion:Antituberculous treatment in such patients shows signs of clinical and radiologic improvement. Link: http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/390/522

A paediatric case of multidrug-resistant tuberculosis in which endo-oesophageal ultrasound-guided fine-needle aspiration using an endobronchial ultrasound-guided bronchoscope was used to collect a sample for microbial analyses is presented. In our experience, ultrasound-guided sampling techniques, both endo-oesophageal and endobronchial, can be safely used for the diagnosis of paediatric intrathoracic tuberculous lymphadenopathy in children aged 3 years. Interventional pulmonologists with experience in using these techniques should be part of the multidisciplinary team treating these patients.

Tuberculous lymphadenopathy can paradoxically increase in size after initial clinical improvement. This paradoxical reaction during tuberculosis treatment is more common among HIV positive than non-HIV patients. However paradoxical reaction must not be primary diagnosis and it is crucial to be sure about patients ˋ good compliance in using antituberculosis medications as well as having sensitive mycobacterial strain. In addition other pathological problems (eg. neoplasia, other non tuberculous mycobacterial infections) should be excluded. We report a case of pleural tuberculosis, complicated by cervical lymphadenopathy near the end of her treatment.

Tuberculous-infected aortic aneurysms are rare, but delayed diagnosis can lead to serious complications, including sudden aortic rupture. Here, we report a case of a tuberculous infected aneurysm in the thoracic aorta that was mistaken for lymphadenopathy. In this case, we could differentiate the lesion with the aid of contrast-enhanced computed tomography and positron emission tomography (PET). This case demonstrates the diagnostic value of PET in aortic aneurysms. (Korean J Med 2015;89:323-326)

The association of immune thrombocytopenic purpura and tuberculosis is extremely rare. We presented a case with tuberculous lymphadenopathy and immune-mediated thrombocytopenia, the complete remission with anti-tuberculous therapy, and partial response to immunoglobulin and steroid suggested a causal relationship between the two conditions.

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. Results A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.

We report a case of pituitary tuberculosis which presented as a non-functioning pituitary macroadenoma, and subsequently developed multidrug-resistant tuberculous lymphadenopathy. Pituitary tuberculosis continues to be a rare presentation of tuberculosis, but incidence and prevalence are expected to grow with increasing numbers of multidrug-resistant tuberculosis. Isolated pituitary tuberculosis is rare. Tuberculosis should be considered in the differential diagnosis in evaluation of a sellar mass.

Background: Lymphadenopathy is the common form of extrapulmonary tuberculosis (TB) in the developing country like India. The aim of the study was to assess the clinical and the pathological features of tuberculous peripheral lymphadenopathy along with the effect of the antitubercular drugs on its clinical course. Materials and Methods: A prospective study was carried out in the department of pulmonary medicine from July 2013 to June 2014. Clinico-demographical and pathological characteristics of the patients of tuberculous lymphadenopathy were studied. Results: Two and four cases, 84 (41.2%) male and 120 (58.8%) females were diagnosed as the cases of tuberculous lymphadenopathy. Mean age of the patients were 28.45 ± 12.83. Palpable mass (100%) was the most common presenting feature. Cervical lymphadenopathy (92.6%) was the most common presentation of peripheral tuberculous lymphadenopathy. Most common cytological pattern seen was epithelioid granuloma with caseous necrosis (32.84%) followed by epithelioid granuloma without caseous necrosis on fine needle aspiration cytology (FNAC). Directly observed treatment short course (DOTS) for TB was effective in treating tuberculous lymphadenopathy. Conclusion: Tuberculous lymphadenopathy affects female more often than males. FNAC is the effective mean in diagnosing tuberculous lymphadenopathy. DOTS is the effective mean for treating tuberculous lymphadenopathy.

In spite of low sensitivity and specificity, standard diagnostic algorithm recommends fine needle aspiration cytology (FNAC) and direct microscopic screening for acid-fast bacilli (AFB) for the routine diagnosis of tuberculous lymphadenopathy (LNTB). In this study, the diagnostic utility of liquid broth based automated culture (BacT/ALERT 3D) technique was assessed in comparison with conventional techniques in 89 clinically suspected tubercular lymphadenitis patients. 60% (n = 53) were positive by FNAC and 38.4% (n = 34) demonstrated AFB in smear examination. BacT/ALERT yielded isolation in 43.1% (n = 38) aspirates, confirming tubercular aetiology. We also found six paediatric culture-positive cases which showed negative outcome by both FNAC and smear. Thus, we conclude that culture by BacT/ALERT, may be used for faster yield of Mycobacteria in LNTB, especially in children. Additionally, this could also be used as a platform for further differentiation of Mycobacterium tuberculosis from non-tuberculous mycobacteria (NTM) infection and for testing of anti-tubercular chemotherapeutic agents whenever drug resistance is suspected.

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the frequent affected site. Ultrasound is a useful noninvasive imaging modality in the assessment of cervical lymph nodes. The morphology of lymph nodes is evaluated by grey-scale sonography and the power Doppler sonography helps in the assessment the vasculature of lymph nodes. Tuberculous lymphadenitis exhibits distinctive features like presence of adjacent soft tissue edema and matting of nodes. This article highlights the use of ultrasonographic as a diagnostic approach, by comparing and differentiating the features of tubercular lymph nodes in a 10-year-old female patient.

Myocardial tuberculosis (TB) is an exceptionally rare form of extrapulmonary TB [(1)][1]. It is a serious illness with varied clinical manifestations (conduction blocks, ventricular failure, malignant ventricular arrhythmias, and sudden cardiac death) and has been occasionally documented in case

Tuberculosis is a major public health problem in India and other developing countries and has formed a lethal partnership with AIDS. It often presents a diagnostic challenge especially when clinical presentation is suggestive but bacteriological proof is lacking. The objective of this study was to compare the various diagnostic techniques in clinically suspected cases of tubercular lymph nodes and to find a suitable, cost-effective but sensitive and specific method for diagnosis. A total of 100 cases were recruited for the study. Fine needle aspiration cytology was done in all cases and the smears prepared were processed for Giemsa, Ziehl–Neelsen's, Kinyoun and Papanicolaou stains. Parts of the aspirated materials were assessed by fluorescent staining, culture and PCR. Seventy-four percent of aspirates were positive by fluorescent stain while only 22 % were positive by culture. PCR could be performed in 55 cases, out of which 22 (40 %) were positive. When compared to culture, the sensitivity and specificity of PCR were found to be 89.5 % and 86.1 %, respectively. Fluorescent stain was found to be the most sensitive (81.8 %) of the conventional methods but showed poor specificity (28.2 %). Interestingly, PCR detected 80 % of smear-negative but culture-positive cases.

Chronic peripheral lymphadenopathy in adults is an indication of pathology of which tuberculosis is the commonest in the developing countries. Presented is a 36-year-old with a huge chronic Submental lymphadenopathy in a seronegative patient of 7 years duration. Histology revealed non-caseating tuberculosis. Tuberculosis should be considered in Submental lymphadenopathy. Despite the long duration, the absence of cold abscess, and or sinus formation may be an indication of the non-caseating tuberculous lymphadenopathy.

We report on a 14-month-old girl who presented with a partially calcificated mediastinal mass suspicious for a malignancy. At thoracotomy, caseous lymphadenopathy, secondary upper lobe atelectasis, and pneumonia were disclosed. This case clearly shows that tuberculosis has to be taken into differential diagnosis for tumor-like mediastinal processes even in low incidence countries.

Background: Retrospective observation analysis to evaluate the outcome of six month treatment regimen, CAT-III and CAT-I, for all patients diagnosed with tubercular lymphadenopathy at M.G.M. Medical College and M.Y. Hospital, Indore, India from January 2006 to December 2008. Materials and Methods: Out of 3158 cases of tuberculosis, there were 337 (10.67%) lymphnode cases; 31 (9.19%) HIV positive and 11(3.26 %) defaulters were excluded from the study. Of the remaining 295 cases of lymphadenopathy enrolled, 240 were on CAT-III and 55 cases of complicated lymphadenopathy were on CAT-I. All patients were followed for six months, to monitor response and complications. Patients with abscess formation or sinus formation underwent aspiration, AFB smear and culture sensitivity. In patients with persistent lymphadenopathy, repeat FNAC of the gland and in cases of hard lymphnode excision biopsy was done before receiving re-treatment regimen category -II or reserved drugs. Result: Out of 295 patients, 212 (71.86%) responded to treatment, however, 83 (28.14%) did not show response at the end of treatment. Of the 83 patients, 54 (65.06%) responded to re-treatment regimen CAT-II, while 29 (34.93%) were found to be drug resistant and were given second line anti tubercular drugs. In the follow-up at six months and later after the end of treatment, 11 (5.18%) relapse was seen. Conclusion: In our study, success rate of currently recommended regimens, category III and I under the revised national tuberculosis control programme in tubercular lymphadenopathy was 71.86%; with 28.34% of patients requiring re-treatment regimen. This requires a lager study involving more number of patients to prove adequacy of regimen.

Summary We here report a case of mediastinal tuberculous lymphadenopathy presenting as superior cava vena syndrome (SCVS). It was a 68-year-old male patient, who had been admitted to hospital because of cough over 3 months. Chest computed tomography (CT) scan revealed a mass in the superior lobe of right lung, and the widening mediastinum that compressed the superior cava vena (SCV). Mediastinoscopy biopsy indicated that it was nonmalignant tuberculous lymphadenopathy. After successful anti-tuberculosis chemotherapy, the upper mediastinum diminished.

Cystic pancreatic neoplasms are tumors with malignant potential treated surgically. Isolated tuberculosis of celiac lymph nodes is rare, treatment of this entity being non-surgical. Radiological appearances of cystic pancreatic neoplasm and tuberculous peripancreatic lymph nodal mass is similar and difficult to differentiate. Here we present a case of mass lesion in the region of pancreatic head mimicking cystic pancreatic neoplasm which was actually abdominal tuberculous lymphadenopathy proven by biopsy.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is becoming more common for diagnosing intrathoracic lymphadenopathy, including tuberculous lymphadenopathy. We herein report two cases of complications possibly related to EBUS-TBNA for tuberculous lymphadenopathy. The first patient was a 26-year-old woman who developed intrabronchial polypoid granulomas exclusively at puncture sites two months after undergoing EBUS-TBNA. Although endobronchial extension may occur, the risk of aggravation caused by puncture should be considered. The second patient was a 39-year-old woman with transient smear-positive bloody sputum that developed immediately after EBUS-TBNA and persisted for three days. Temporary isolation following EBUS-TBNA should be considered for possible tuberculous lymphadenopathy.

Setting Eight operational locations for the Revised National Tuberculosis Control Programme in six Indian states. Objective To assess the 6-month efficacy of an intermittent thrice-weekly directly observed treatment (DOT) regimen for tuberculous peripheral adenopathy and the need for prolongation of treatment to 9 months for non-resolution of lymphadenopathy. Design Patients aged >5 years with tuberculous lymphadenopathy were included in the study. Patients were evaluated for resolution at repeat visits following treatment. Those with poor resolution at 6 months were randomised to extended treatment up to 9 months or observation without additional treatment. Results Resolution of lymphadenopathy was observed at the end of 6 months in 517/551 (93.8%) patients. There was a significant difference in response among patients with and those without the presence of systemic symptoms. There was no association between treatment response and number, size, site, consistency and matting of lymphadenopathy. No differences in response were seen in the remaining 34 patients with or without extended treatment. Conclusion The operational efficacy of 6-month thrice-weekly DOT for peripheral tubercular lymphadenopathy was satisfactory. There was no evidence of additional benefits of prolonging treatment to 9 months.

To assess the diagnostic value of computed tomography (CT) imaging in screening for abdominal nonhematogenous disseminated tuberculous lymphadenopathy (TL).The CT scans of 12 patients with abdominal nonhematogenous disseminated TL suggestive of neoplasm were retrospectively analyzed in this review. The final diagnoses were confirmed by lymph node pathology for seven patients and by laparoscopic surgery for five patients. All of the patients were treated at our institution between April 1995 and August 2009.The sites of involvement were the periportal (n = 6), peripancreatic (n = 3), periaortic (n = 3), and mesenteric (n = 2) regions. On the plain CT scan, the lymphadenopathy showed a heterogeneous isodensity or hypodensity in 11 patients and a low density in one patient. Peripheral enhancement was observed on the dynamic contrast-enhanced CT scans for all patients. In two cases, scans were more revealing during the portal venous and delayed phases.Abdominal lymphadenopathy with predominant peripheral rim-like enhancement on the dynamic contrast-enhanced CT scan may suggest a diagnosis of TL.

We experienced a case of abdominal tuberculous lymphadenopathy which was difficult to be distinguished from metastatic disease and malignant lymphoma with various radiographic modalities and its clinical course. A 31-year-old man was seen at the hospital because of fever and cough. Chest X-ray revealed pleural effusion and abdominal ultrasography showed a tumor near the pancreas head. Pleural effusion was diagnosed as tuberculous pleuritis and treated by isoniazid, rifanpicin and streptomycin. From the clinical course, the tumor near the pancreas head was suspected of relating to abdominal tuberculous lymphadenopathy, but no definite diagnosis could be attained by abdominal CT, endoscopic retrograde cholangiopancretogram, and abdominal angiogram. Moreover, since no change or decrease in size of the tumor was observed with the tuberculochemotherapy, we were left to examine a possibility of a malignant disease and proceeded to perform an exploratory laparatomy. We admitted the difficulty to establish the differential diagnosis of Abdominal lymphadenopathy.

Summary The chemotherapy of tuberculous lymphadenopthy, the commonest form of extra-pulmonary tuberculosis, is reviewed and a recommendation made for the treatment of this condition in children. Fifteen papers were identified recording the treatment and follow-up of 1133 adults and children with six-month isoniazid and rifampicin based regimens. In 32 (2.8%) cases treatment was recommenced, but in only one case was relapse microbiologically confirmed and in a further four histology was compatible with tuberculosis. Four studies enrolling 484 adults and children, record the follow-up of patients receiving 6–18 months treatment with INH and RMP based regimens; treatment was recommenced in 24 (5%), but in no case was relapse confirmed microbiologically. Five papers describe the treatment and follow-up of 246 adults and children receiving nine-month INH and RMP based regimens and record the recommencement of treatment in 4 (1.6%) cases, but in no case was relapse confirmed microbiologically. Four controlled studies failed to show any advantage for treatment regimens longer than six months. Paradoxical recurrence and worsening of clinical features was common during and following all regimens being recorded in from 3 to20% of patients. Very seldom were these events accompanied by evidence of culture of Mycobacterium tuberculosis to confirm microbiological failure to respond or relapse. Tuberculous lymphadenopathy in children can be safely treated with six months of INH and RMP with PZA given for the first two months and accompanied by EMB in areas with a high prevalence of drug resistance. Every effort should be made to confirm the diagnosis and possible relapses microbiologically.

症例は32歳男性. 1996年からBehcet病にてプレドニゾロン内服中(総投与量8400mg). 1998年8月に肝機能異常・黄疸を指摘.腹部超音波検査で膵頭部に径4cmの腫瘤性病変を認め,腹部CT, MRIで辺縁が濃染される腫瘤を認め,腹部リンパ節結核によるリンパ節腫大が疑われた.腹腔鏡下生検にて,好酸菌染色でリンパ節内の結核菌が同定された.抗結核剤投与にてリンパ節は縮小した.

The results of a consecutive series of 1,349 fine needle aspiration (FNA) biopsies from the head and neck region of 1,193 patients has been reviewed in order to evaluate the efficacy of this method in the diagnosis of tuberculous lymphadenopathy (TBLN). Of the 108 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 68 had subsequent surgery and histological confirmation of the cytological appearance. Sixty-three had TBLN, thus the specificity of FNAC was 93 per cent in diagnosing tuberculous related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be metastatic mucoepidermal carcinoma.Of the 1,193 patients, 90 patients had subsequently TBLN confirmed histologically. Of these 90 patients, FNA from 69 showed granulomatous changes or acid fast bacilli (AFB), thus the sensitivity of FNAC in detecting tuberculous lymphadenopathy was 77 per cent. Fifty-two cytological smears were stained for acid fast bacilli. Nineteen (37 per cent) contained AFB. It is evident from this review that FNAC is an efficient way to detect cervical tuberculous lymphadenopathy.

Background: Fine-Needle Aspiration Biopsy (FNAB) is a diagnostic technique which has achieved widespread use and acceptance. Its clinical use has continued to widen with the availability of more sophisticated methods of imaging. Its minimal invasiveness, cheap cost and easy application make it a technique of choice in investigating swellings even in children. Aims and objectives: To investigate the reliability, safety and diagnostic value of FNAB in superficial masses including lymph nodes in children. Patients and methods: Superficial masses and lymph nodes of twenty consecutive children aged 2-13years were subjected to FNAB. Open biopsies were also performed on them to validate the FNAB. All specimens were subjected to examination by a cytopathologist and a histopathologist. Results: Nine of the patients (45%) had malignant diseases (lymphoma and osteosarcoma); seven had tuberculous lymphadenopathy while four had reactive lymphadenitis. Open biopsies corroborated these findings. There were no false-negative or false-positive cytology results from aspirates. There were no complications related to the procedures. Conclusion: Fine-needle aspiration biopsy is a reliable, safe, less invasive and relatively cheaper alternative method of establishing a pathologic diagnosis, compared to open biopsy, in children. Key Words: Cytology, Children, Fine needle aspiration biopsy. Resume Introduction:- La Biopsie d'aspiration d l'aiguille fine ‘Fine-Needle aspiration Biopsy' (FNAB) est une technique diagnostique l'utisation et acceptabilite de laquelle est largement repandue. Son utilization clinique continue a s'elargir avec la disponibilite de la methode d'imagerie medicale plus sophistiquee. Sa nature invasive minimale, du bon marche et application facile donnent a cette technique de choix dans Ie diagnostic de la tumefaction meme chez des enfants. Buts et Objectifs:- Etudier la fiabilite, Ie sans danger et la valeur diagnostique de FNAB dans des masses superficielle y compris ganglion lymphatique chez des enfants. Patients et Methodes:- Des masses superficielles et des ganglions lymphatiques de vignt enfants consecutifs âges 2 - 13 ans ant subi la FNAB. On avait egalement opere les biopsies couvertes chez des patients afin de confirmer la FNAB. Tous les specimens ont ete exposes a I'examen par un cytopathologiste et un histopathologiste. Resultats:- Neuf d'entre les patients soit 45% etaient atteints des maladies malignes (lymphoma et osteosarcome); sept atteints de la lymphadenopathie reactive tandis que quatre atteints de la tuberculose lymphadenite. Des biopsies ouvertes ont confirme ces resultats. II n'y avait pas de resultats cytologique fausse positive ou fausse negative a partir des aspirers. II n' y avait aucune complication liee aux protocols. Conclusion:- La biopsie de l'aspiration d'aiguille fine est fiable, sans danger, moins invasive et relativement du tres bon marche un autre methode de confirmer un diagnostic pathologique par rapport a la biopsie ouverte chez des enfants. West African Journal of Medicine Vol.23(3) 2004: 221-223

Vocal cord paralysis because of involvement of recurrent laryngeal nerve by benign and acute inflammatory lymphadenopathy is a rare condition. Presented here is a case of tuberculous lymphadenopathy of superior mediastinum causing left recurrent laryngeal nerve paralysis, which was successfully treated by antituberculosis treatment, with complete recovery of vocal cord function.

An analysis of 33 patients with histologically confirmed intrathoracic tuberculous lymphadenopathy was made. Tuberculosis could have been diagnosed without mediastinoscopy only in 3 patients: 2 had positive bronchial cultures and 1 simultaneous cervical lymph node tuberculosis. Bacteriological confirmation is conclusive, but seldom possible. Mediastinoscopy provides the best method to obtain tissue samples, and consequently, it is still necessary in the diagnosis of intrathoracic tuberculous lymphadenitis.

Sonographic and computed tomography findings were retrospectively compared in 13 patients with proven abdominal tuberculosis who had both diagnostic modalities in their workup. The patients were treated over 9 years in two general hospitals in Kuwait. Ultrasound could detect the same findings as CT in 9 of 13 patients. Both had the same accuracy in detecting the type of ascites (in 6 patients) and solid organ tuberculosis (four lesions). Ultrasound gave useful information but could not completely replace CT as it detected less bowel thickening (3 of 5 lesions) and abdominal tuberculous lymphadenopathy (1 of 4 lesions) than CT scanning. © 1995 John Wiley & Sons, Inc.

Introduction and Objectives Tuberculosis notifications in the UK continue to rise and the diagnosis of both disease and drug resistance can be challenging. Endobronchial ultrasound (EBUS) and EBUS-guided transbronchial nodal aspirates (TBNA) have been shown recently to be a safe and effective tool in the diagnosis of intra-thoracic TB lymphadenopathy. New molecular techniques, notably the GeneXpert MTB.Rif system (Cepheid) have shown great promise in the diagnosis of pulmonary disease but have not been evaluated in intra-thoracic nodal disease. Methods As part of an ongoing study, consecutive patients with intra-thoracic lymphadenopathy were prospectively studied within our tertiary EBUS service between January 2010 and March 2011. In addition to standard cytological and microbiological investigations, a single GeneXpert MTB.Rif assay was performed on EBUS-TBNA samples. Using established methods, a final diagnosis was given of definite/highly probable TB, possible TB or not TB/alternative diagnosis. Performance of the GeneXpert MTB.Rif assay was then evaluated in the context of these final diagnoses. Results 74 patients (3 HIV-positive) underwent EBUS-TBNA sampling. Nineteen have been diagnosed with definite/highly probable TB to date. A single GeneXpert assay had a sensitivity of 67% (8/12) from culture-positive TBNA. 11/15 (73%) of patients with a positive culture from any tissue and 13/19 (68%) patients classed as definite/highly probable TB had positive GeneXpert results. One case of confirmed MDR-TB was correctly identified and treatment started promptly. Fifteen patients had positive GeneXpert MTB.Rif results from EBUS-TBNA: 13/15 were given immediate TB treatment. One of the remaining two cases without strong microbiological or cytological findings was subsequently diagnosed with active tuberculosis supported by evidence of PET-positive mediastinal lymph nodes. The other case appears not to have active disease and remains under follow-up. Conclusions A single GeneXpert MTB.Rif assay has good sensitivity in the context of culture-positive intra-thoracic tuberculous lymphadenopathy and can provide an immediate diagnosis of likely MDR-TB. Positive PCR results were seen in two patients where conventional techniques were inconclusive and in one provided the main support for the diagnosis. These results suggest the addition of the GeneXpert MTB.Rif assay to the investigation of intra-thoracic nodal disease improves diagnostic yield.

wide array of manifestations. Although the involvement of liver, spleen, bowel, and mesenteric lymph nodes is commonly seen in miliary tuberculosis, tuberculosis affecting only the peripancreatic lymph nodes is a rare clinical entity (1). Correct diagnosis is crucial in establishing adequate management and treatment. Its occurrence may pose a diagnostic challenge due to its similarity with a pancreatic neoplasm. We present a rare case of peripancreatic tuberculous lymphadenopathy which was misdiagnosed as a pancreatic neoplasm.

Tuberculosis remains prevalent in developing countries and has recently re-emerged in the Western world. Intra-abdominal tuberculosis can mimic a variety of other abdominal disorders, and here we describe a patient with solitary tuberculous mesenteric lymphadenopathy mimicking duodenal gastrointestinal stromal tumor (GIST). A 22-year-old woman complained of epigastric discomfort and was presumed to have a duodenal GIST after an endoscopic examination and abdominal CT scan. However, exploratory laparotomy revealed an enlarged node penetrating the duodenal bulb, which was diagnosed histopathologically as tuberculous lymphadenitis. This case suggests that in regions with a high prevalence of tuberculosis, intra-abdominal tuberculosis is often mistaken as a malignant neoplasm. A high index of suspicion and the accurate nonsurgical diagnosis of intra-abdominal tuberculosis continues to be a challenge.

A 46-year-old man with fever and pancytopenia was found to have a myelodysplastic syndrome. During the course of the illness, he had localized cervical tuberculous lymphadenitis. We believe this association of the myelodysplastic syndrome with localized tuberculosis has not been previously described.

A retrospective radiographic comparison of two regimens, RHE2/RH10 (n = 32) and RHZ2/RH10 (n = 37), used in the treatment of tuberculous mediastinal lymphadenopathy is reported. The two groups did not differ in age, pretreatment or post-treatment values. The rate of improvement in serial radiographs was compared between the two groups, each patient acting as his own control. There was no difference in the incidence of initial gland enlargement at 1 month, but at 2 months RHZ2/RH10 had less enlargement (0.05 greater than P greater than 0.01). The rate of improvement was faster in the RHZ2/RH10 group from 2-7 months' treatment, being significantly better than RHE2/RH10 at 2 (P = 0.003), 5 (0.01 greater than P) and 7 months (0.02 greater than P). Pyrazinamide (25-40 mg/kg) appears to be superior to ethambutol 15 mg/kg for the initial 2 months of treatment of tuberculous mediastinal lymphadenopathy. The findings may be applicable to peripheral tuberculous lymphadenopathy.

Eighty consecutive cases of tuberculous lymphadenopathy confirmed by histological examination were reviewed. Fifty-five cases (69%) were followed up for more than two years. Excluding twelve cases with incomplete chemotherapy, the results of treatment by combined surgery and chemotherapy in the remaining 43 cases were analysed. Twelve cases had complete excision of all grossly involved lymph nodes; all did well. Twenty-one cases had only representative lymph nodes biopsied for diagnosis, five of them (24%) required a second operation – three for abscess formation and two for progressive enlargement of the residual lymph nodes. Seven cases of tuberculous abscesses were treated by a simple drainage procedure, and despite chemotherapy, all had persistent wound discharge for over one month which required a second operation to remove the underlying caseating lymph nodes. Results suggest that all easily accessible tuberculous lymph nodes should be removed and that persistent discharging sinuses should also be treated by surgery.

A case of psoas abscess occurring during treatment of tuberculous lymphadenopathy is described. There was no evidence of a bony origin for this abscess. It appears likely that it arose from involved glands on the posterior abdominal wall.

A previously healthy 33 year old lady presented with acute dysphagia with endoscopic and CT features of oesophageal carcinoma. Endoscopic ultrasound (EUS) revealed a large subcarinal lymph node compressing at the mid-oesophagus. Fine-needle aspiration (FNA) showed a single well-formed epithelioid granuloma with no evidence of malignancy. Molecular analysis showed the aspirate to be positive for Mycobacterium tuberculosis. She continues to improve with standard anti-TB medication without surgery.This is a rare case of acute dysphagia secondary to primary tuberculous mediastinal lymphadenopathy. EUS and FNA have completely altered the clinical management of this lady.

INTRODUCTION ALMOST six years have elapsed since we reported on the progress in the field ". of tuberculosis of the upper respiratory tract. During this interval considerable progress has been made in the treatment of tuberculosis, particularly since the discovery of streptomycin and paraaminosalicylic acid (PAS). Since the clinical results of the combined use of the two drugs have begun to appear in the international literature, it has become increasingly difficult for us to keep up to date on this particular aspect of otolaryngological tuberculosis. The number of papers published on streptomycin and PAS therapy and on the clinical results and complications are most formidable. At the same time, the major indexing surveys have lagged chronologically behind the countless and dispersed publications. Another drug of therapeutic interest in the treatment of lupus and tuberculous lymphadenopathy proved to be calciferol, which apparently was found to be of great value in