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The objective: to evaluate the possibilities of ARFI technology (Acoustic Radiation Force Impulse), including Virtual Touch™ Tissue Imaging (VTI) and Virtual Touch™ Tissue Quantification (VTQ) for differentiation of lymphomatous and metastatic superficial lymphadenopathy.Materials and methods. The prospective study included 138 patients with enlarged superficial lymph nodes (LN). Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd group (n = 30) – patients with metastasis of solid tumors in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology. In VTI study the Area Ratio parameter was evaluated, and the minimum and average values of the shear wave velocity were estimated in VTQ study.Results. According to the results of VTI study the Area Ratio parameter for enlarged LN in lymphoma (1st group) and for metastatic lymphadenopathy (2 nd group) were 1.031 ± 0.197 and 0.851 ± 0.15, respectively (p = 0.000009). The cut off value of the Area Ratio parameter was 0.901 with sensitivity, specificity and accuracy 80.6, 70.0 and 78.8 %, respectively. Minimum values of shear wave velocities for 1st and 2 nd groups were 1.980 ± 0.557 and 2.214 ± 0.367 m/s, respectively (p = 0.032). The cut off values of the average shear wave velocity in the differentiating of lymphomatous and metastatic lymphadenopathy are determined at the level of 2.00 m/s, with sensitivity of 70.0 %, specificity of 59.3 %, and accuracy of 61.6 %.Conclusion. Ultrasound elastography with ARFI technology demonstrated statistically significant differences in the Area Ratio parameter and in the minimum shear wave velocity in the enlarged superficial LN in lymphoma and with metastasis that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions. Moreover, the Area Ratio parameter has a statistically more significant effect on differentiating of lymphomatous and metastatic lymphadenopathy.

Introduction: The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. Materials and Methods: A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. Results: We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (n = 13; 3.58%), benign (n = 208; 57.30%), atypia of uncertain significance (n = 7; 1.93%), suspicious (n = 21; 5.79), and malignant (n = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. Conclusion: The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107

Primary cutaneous and systemic plasmacytosis is a rare disorder characterized by infiltration of the skin by polyclonal plasma cells of unknown etiology, frequently accompanied by polyclonal hypergammaglobulinemia and diffuse superficial lymphadenopathy. It primarily arises in patients of Japanese descent, and it is exceedingly rare in Caucasians. We describe a 36-year-old Portuguese male who presented with disseminated reddish-brown plaques over the trunk, neck, and upper limbs with normal gammaglobulinemia consistent with a diagnosis of primary cutaneous plasmacytosis.

Introduction: The causes of superficial lymphadenopathy are diverse and their prognosis is often unknown. The diagnosis of superficial lymphadenopathy remains a challenge because, alone, its clinical picture doesn’t allow differentiating between an infec...

Objective To explore the radiological and histological findings characteristic of AIDS related Burkitt lymphoma. Methods Radiological and histological data from 4 patients with AIDS related Burkitt lymphoma were retrospectively analyzed. All the 4 patients received CT scanning and MR imaging. Of the 4 patients, 3 underwent surgical removal of lymphoma and the other 1 was performed aspiration biopsy. Results All the 4 patients were detected with superficial lymphadenopathy, with 2 at the neck and the other 2 at the armpit. Extra-nodal invasion were found in 3 patients, of which 2 had multi-organ lesions. Their diagnoses were histologically defined to be Burkitt lymphoma. Conclusion AIDS-related Burkitt lymphoma is radiologically shown as lymphadenopathy and multi-organ involvement. Diffuse tumor cells with moderate sizes exist in intra- and extra-nodal tissues, characterized by stars-in-the-sky sign. Immunohistochemically, both CD10 and CD20 are positive, and the positive rate of Ki67 is almost up to 100%.

The aim of the paper is to provide a comprehensive overview on the applications of real time sonoelastography (SE) in the diagnosis of superficial lymphadenopathy. Some technical aspects of performing SE are presented as a preamble. The typical appearance of benign and malignant nodes is illustrated. The paper discusses and depicts the various elastographic scores in use. It also provides a critical appraisal of the relative strain ratio (SR) or stiffness index. Shear wave elastography, as a novel technique, is mentioned. In conclusion, hardness on more than 50% of the node surface or SR > 1.5 is fair to good indicators of malignancy. Work is still needed both to fully understand the various appearance of disease and to standardize the application.

PURPOSE: Recent studies have reported high accuracy of power Doppler sonography (PDS) and color Doppler sonography (CDS) in the differentiation of benign and malignant peripheral superficial lymphadenopathy. This study was conducted to determine whether PDS can differentiate benign from malignant abdominal lymph nodes on the basis of defined vascular patterns. MATERIALS AND METHODS: We retrospectively evaluated 88 color pictures of abdominal lymph nodes (39 benign lymph nodes, 24 malignant lymphomas, 25 lymph node metastasis) done in the power Doppler mode. The goal was to determine whether benign and malignant abdominal lymph nodes can be differentiated in power Doppler sonography on the basis of 9 defined vascular patterns. RESULTS: Three vascular patterns showed a significantly (p < 0.05) higher appearance in malignant than in benign lymph nodes: aberrant vessel (specificity 87 %), avascular focus (specificity 92 %) and subcapsular vessel (specificity 100 %). The vascular pattern hiliar vessel showed a significantly higher appearance in benign lymph nodes (specificity 87.8 %). CONCLUSION: Three vascular patterns are detectable in power Doppler mode (avascular focus, aberrant vessel, subcapsular vessel) in abdominal lymph nodes, which are typical for malignant abdominal lymphadenopathy. The presence of one of these vascular patterns means with a high specificity (87 - 100 %) that an abdominal lymphadenopathy is malignant. One vascular pattern (hiliar vessel) shows a significantly higher appearance in benign lymph nodes.

OBJECTIVE The purpose of this study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. METHODS Ninety-four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast-enhanced sonograms were analyzed using contrast-specific quantification software. All of the results were compared with pathologic diagnoses. RESULTS Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast-enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time-intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). CONCLUSIONS These results indicate that the use of CEUS and contrast-specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time-intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.

To determine the accuracy of fine-needle aspiration (FNA) in the diagnostic assessment of lymphadenopathies, a retrospective study was conducted on 627 cases of FNA of the lymph nodes performed at Department of Pathology, UNIFESP (Federal University of Sao Paulo), between 1997 and 2001. Cytology results were compared to the results of biopsies if available. The cytological diagnosis was unsatisfactory in 14.7% of cases, positive in 46%, and negative in 39.3%. Among the positive cases, 79.4% were classified as metastases, 14.2% as lymphoma, and 6.4% as indeterminate. Anatomopathological exams for the determination of cytohistological correlation were available in 218 of the 627 cases. There were three (1.88%) false-negative and two (1.25%) false-positive cases. Accuracy tests revealed 97.41% sensitivity, 95.45% specificity, and 96.88% efficacy, with cytohistological agreement being almost perfect (κ = 0.92). The high accuracy of this study based only on cytomorphological criteria associated to the variety of malignant neoplasias diagnosed by the procedure demonstrates its relevance on patient care, especially in areas of limited financial resources. Diagn. Cytopathol. 2006; 34:130–134. © 2006 Wiley-Liss, Inc.

Introduction: In pediatric population Fine-Needle Aspiration Citology (FNAC) is slowly gaining acceptance in clinical management of Superficial Lymphadenopathy (SL). Our experience adds some data about the usefulness of this technique in diagnosing the cause of a SL and therefore guiding further treatment. Patients and Methods: 238 FNAC were performed in 217 patients with SL, observed at our Institution from 2002 to 2006. The neck was the most frequent localization. The results were available within few hours. In cases of granulomatous findings, the samples were processed for microbiological and PCR test, in order to identify Mycobacteria. Results: 174 were reactive lesions, 38 granulomatous lymphadenopathies, 24 malignant lesions, 2 specimens inadequate for diagnosis. Among the 174 reactive SL, 22 required an incisional biopsy after 1 month follow-up. Among the granulomatous lymphadenopathies, 13 children with Cat-Scratch Disease recovered, 25 with Mycobacteria infection underwent surgical excision. For 24 malignant lesions, the diagnosis was confirmed by further biopsy. Two false negative and no false positive were detected (sensitivity 92%, specificity 100%). No complications were encountered. Conclusions: In our experience FNAC, performed by experienced cytopathologist, has revealed to be a fast, safe, non invasive and inexpensive method to achieve diagnosis in persistent SL. The use of FNAC gave us the possibility to select patients for further investigation and/or surgical treatment. Incisional biopsy remains necessary to confirm the diagnosis in case of malignancy or doubtful lesions.

The first autochthonous case of acute/subacute disseminated paracoccidioidomycosis observed in a child in Rio Grande do Sul (Brazil) is reported. The disease started with widespread superficial lymphadenopathy six months before the patient was admitted to the hospital. The diagnosis was made through a cervical lymph node biopsy. The spectrum of the clinical forms of the mycosis observed in this State is commented upon.

BACKGROUND Fine-needle aspiration biopsy (FNAB) is an important tool for the cytologic assessment of patients with lymphadenopathy. The nonaspiration method (without the use of a syringe or a handle), or fine-needle capillary biopsy (FNCB), is becoming popular for its ease of learning and use. The authors compared the two techniques of fine-needle biopsy (with and without aspiration) for identifying the cause of superficial lymphadenopathy. METHODS Over a 2-year period 50 cytologic examinations were conducted in patients with superficial lymphadenopathy. Both procedures were performed at the same site; the order in which they were performed was determined randomly. Slides were fixed in a similar manner and examined by a cytotechnologist and pathologists blind to the procedure. Scores were tabulated and compared and diagnosis was confirmed by histologic examination. RESULTS The best and the average score for the yield of cellular material was higher with FNCB (P < 0.004). Cell preservation also was superior with FNCB (P = 0.00066). However, the failure rate was lower with FNAB (P = 0.7662). CONCLUSIONS FNCB of superficial lymph nodes yields adequate cellular material of superior quality, which may be advantageous in certain situations. However, the diagnostic yield does not appear to be significantly increased using this technique. Cancer (Cancer Cytopathol) 1997; 81:277-80. © 1997 American Cancer Society.

Cutaneous plasmacytosis is a rare disease characterized by peculiar multiple eruptions and hypergammaglobulinemia. More than 40 cases have been reported, mainly in Japan, although information concerning the disorder was limited to individual case reports.To clarify the clinicopathological and laboratory features, we reviewed 41 cases.All patients were Japanese and the male-to-female ratio was 1:0.6. The onset ages ranged from 20 to 62 years, with a mean and median of 37 and 37 years. A superficial lymphadenopathy was detected in 58% (22/38), and polyclonal hypergammaglobulinemia was found in 93% (38/41). No cases were associated with any apparent underlying diseases. The course was chronic without spontaneous remission. Four patients died, 3 of whom succumbed to leukemia, respiratory failure or renal failure, respectively.The results suggest that the condition appears to be a variant of reactive plasmacytic disorders of unknown origin.

Lymph node fine needle aspirations in 93 patients were studied to ascertain the usefulness of FNA cytology in determining the therapeutic approach. Cytologic results were compared with histologic diagnoses in 35 cases that underwent both aspiration and excisional biopsy. The cases with histological diagnoses included 17 (28.3%) of the 60 cytologically benign cases, 6 (75.0%) of the 8 cytologically suspicious cases, 10 (55.5%) of the 18 cytologically malignant cases and 2 (28.6%) of the 7 cytologically unsatisfactory cases. FNA in the present series showed a sensitivity of 90.0 per cent and specificity of 82.3 percent. It is concluded from this data that FNA can be an accurate, inexpensive and quick method of initial diagnosis in superficial lymphadenopathy. NQJHM Vol. 17 (4) 2007: pp. 144-147

Background: The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South‑Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent. Aim: To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post‑HIV/acquired immune deficiency syndrome (AIDS) era of South‑Eastern Nigeria. Materials and Methods: This is a 15 years (2000–2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku‑Ozalla Enugu, Nigeria. Results: One hundred and seventy‑two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital’s Morbid Anatomy Department during the 15 years period under review. Twenty‑eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl‑Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21–25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively. Conclusions: There is a remarkable decline in the prevalence of TB lymphadenitis in South‑Eastern Nigeria indicating a change in trend from the pre‑ to the post‑HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Ultrasonography has proved a valuable tool for the detection of enlarged lymph nodes; however, differentiation between benign and malignant nodal disease remains a problem. High-frequency probes with improved spatial and contrast resolution display superficial nodes to advantage and also show the internal structure of the nodes. Ninety-four superficial nodes in patients with suspected nodal disease were examined by using 7.5-MHz probes to evaluate longitudinal-transverse diameter ratio (L/T), the central hilus, cortical widening, and size. Histologic diagnosis was obtained after sonographic examination in 73 nodes (five reactive nodes, 35 primary nodal malignancies, and 33 nodal metastases). The remaining 21 nodes regressed after either antibiotic or no therapy. Marked differences were observed among the proportions of benign and malignant nodes in terms of L/T, hilus, and cortex; the latter two structures, however, must be interpreted together. Eccentric cortical widening was seen in only malignant nodes. The distribution of nodal size was not significantly (P greater than .1) different for benign and malignant nodes. No differences were observed between primary and secondary nodal malignancies. The sonographic criteria evaluated in this study assist in the differentiation of benign from malignant superficial lymph nodes.

Purpose : To evaluate the vascular pattern of lymph nodes, and the usefulness of color Doppler sonogaphy in differentiating benign from malignant superficial lymphadenopathy. Materials and Methods : Twenty-six patients were pathologically and clinically confirmed to be suffering from benign reactive lymphadenitis and tuberculosis(n=16) or lymphoma and malignant lymphadenitis (n=10). Lymph node shape was assessed by the ratio of longitudinal diameter to transverse diameter(L/T), and patients were thus assigned to one of two groups : , or L/T, and 3 L/T

Two male patients, aged 36 and 73 years respectively, gradually developed febrile pancytopenia with profound alteration of their general condition and major inflammatory repercussions. No superficial or deep lymph node enlargement was found initially. Patient n degree 2 had an enlarged spleen. In both cases histological examination of the bone marrow showed an extensive and apparently nonspecific myelofibrosis. The subsequent development of superficial lymphadenopathy provided a firm diagnosis of Hodgkin's disease with mixed cellularity. These two cases belong to the category of exceptional massive medullary forms of Hodgkin's disease described by Duhamel et al. in 1979.

A Nigerian male child presented with extensive superficial lymphadenopathy, a bleeding diathesis, and numerous tumour cells in blood and bone marrow. Further characterization of the tumour cells confirmed the diagnosis of Burkitt's lymphoma. The main unusual features shown by this patient are discussed.

The histological sections of 63 English cases of non-leukaemic lymphosarcoma of childhood have been reviewed. On histological criteria 50 cases were classified as non-leukaemic lymphosarcoma, 9 as Burkitt's tumour and in 4 cases an equivocal diagnosis was made. The 9 children diagnosed as having Burkitt's tumour showed a similar clinical and anatomical tumour distribution to cases of Burkitt's tumour described from Africa, with a high incidence of jaw involvement and multiple visceral tumours. In contrast, most of the 50 cases diagnosed as lymphosarcoma presented with superficial lymphadenopathy, tumours of the lymphoid tissue of Waldeyer's ring, mediastinal masses or intussusception. Burkitt's tumour is composed of cells that closely resemble lymphocytes transformed by phytohaemagglutinin. It is suggested that the tumour should be defined and classified on the basis of this cell type. The hypothesis that Burkitt's tumour may be induced by an insect-vectored virus is based mainly on the distribution of the tumour in tropical Africa. The implication of the English cases of Burkitt's tumour, reported here, is discussed in relation to this hypothesis. On a examine des coupes histologiques de 63 lymphosarcomes non leucemiques d'enfants anglais. D'apres les criteres histologiques, 50 cas ont ete classes comme lymphosarcomes non leucemiques, 9 comme tumeurs de Burkitt et dans 4 cas le diagnostic etait incertain. Dans les 9 cas de tumeur de Burkitt, la distribution clinique et anatomique des tumeurs etait semblable e celle des cas de tumeur de Burkitt decrits en Afrique, avec une frequence elevee de l'atteinte maxillaire et des tumeurs viscerales multiples. Par contre, dans la plupart des 50 cas qui ont fait l'objet d'un diagnostic de lymphosarcome, on a trouve une lymphadenopathie superficielle, des tumeurs du tissu lymphoide de l'anneau de Waldeyer, des masses mediastinales ou une intussusception. La tumeur de Burkitt se compose de cellules qui ressemblent etroitement a des lymphocytes transformes par la phytohemagglutinine. L'auteur pense qu'elle devrait etre definie et classee sur la base de ce type cellulaire. L'hypothese que la tumeur de Burkitt pourrait ětre provoquee par un virus transmis par des insectes repose principalement sur la distribution geographique de cette tumeur en Afrique tropicale. L'auteur examine en fonction de cette hypothese les cas de tumeur de Burkitt observes en Angleterre et dont il est rendu compte dans cet article.

Seven cases are presented of an exfoliative erythroderma with intense pruritus, edema, pigmentation, superficial lymphadenopathy, hepatomegaly, leonine facies, alopecia, dystrophic nails, and hyperkeratosis of the palms and soles. A cutaneous infiltrate of atypical mononuclear cells is present in this condition and is associated with an increased leukocyte count and with an abundance of these atypical cells in the peripheral blood. The cell is characterized by a large, convoluted nucleus with a narrow rim of cytoplasm frequently containing numerous vacuoles in a necklace-like arrangement around the nucleus. Within these vacuoles is an intensively PAS-positive, diastase-resistant neutral mucopolysaccharide. Patients with this disease remain in good general condition for a long time. Treatment with superficial irradiation, steroids, and cytotoxic agents yields only temporary relief. Death occurs approximately 5 years after the first symptoms have been noted.

This case is reported because of its interesting features and because it illustrates the use of a new diagnostic aid in confirming a clinical impression of pulmonary sarcoidosis. Frequently a histological diagnosis of Boeck's sarcoid is impossible because there is no superficial lymphadenopathy. In a series of such cases recently reported, a method of obtaining lymph nodes or lymphoid tissue from the fat-filled space overlying the scalenus anticus muscle was described by Daniels.1 REPORT OF CASE The patient, a 48 year old man, was admitted April 5, 1949 "for a check-up." In November 1941 he had had influenza, which persisted despite the usual palliative measures. He was studied at a hospital for six weeks. Because of the chronic cough with expectoration of mucoid sputum, weight loss, fatigue, increased erythrocyte sedimentation rate and appearance of the chest roentgenogram, a diagnosis of pulmonary tuberculosis was made. Results of the sputum studies