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2.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511261

RESUMO

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder affecting multiple organ systems. The awareness of this disease has tremendously increased over the last decade leading to effective treatment and decreased morbidity to the patients. Histopathology plays an important role in the diagnosis of IgG4-RD, and definite histologic criteria are proposed in clinically suspected patients. We report a patient with multiple organ system involvements of the salivary gland, lymph node and kidney. IgG4-related lymphadenopathy (IgG4-RL) in this patient was misdiagnosed as nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL). Refractoriness to treatment for NLPHL and subsequent manifestations of renal involvement lead us to the correct diagnosis of this potentially treatable condition. IgG4-RL can mimic reactive proliferation as well as lymphomas. We report the clinical presentation and discuss the problems faced by pathologists in diagnosing IgG4-RL. We believe that awareness of this rare presentation will enhance the knowledge in diagnosing IgG4-RD.


Assuntos
Doença de Hodgkin/diagnóstico , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/patologia , Linfadenopatia/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Doença de Hodgkin/patologia , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Linfadenopatia/etiologia , Pessoa de Meia-Idade , Nefrite Intersticial/etiologia , Nefrite Intersticial/patologia , Doenças das Glândulas Salivares/etiologia
4.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289155

RESUMO

A 22-year-old female patient was admitted to hospital after being referred from the oral medicine clinic where she had been seen for persistent gingivitis and mouth ulcers. She described an insidious history of persistent fevers, dry cough and unexplained weight loss over 4-6 weeks. Imaging showed extensive bilateral pulmonary nodules with mediastinal lymphadenopathy and two lesions in the pancreas. MRI revealed these lesions to be well-defined fluid-filled cysts in the tail of the pancreas, without features of malignancy. Core biopsies taken from her lung nodules demonstrated features of vasculitis with granulomata. This was consistent with her positive immunology for c-antinuclear cytoplasmic antibodies and proteinase-3, which were sent after her fever failed to settle with antibiotic treatment. In keeping with a diagnosis of vasculitis, the patient showed a significant clinical and biochemical response to intravenous methylprednisolone and high-dose daily prednisolone thereafter.


Assuntos
Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Linfadenopatia/patologia , Administração Intravenosa , Anticorpos Anticitoplasma de Neutrófilos/sangue , Diagnóstico Diferencial , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/metabolismo , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Mieloblastina/sangue , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Resultado do Tratamento , Adulto Jovem
5.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289161

RESUMO

Epstein-Barr virus (EBV) is implicated in the tumorigenesis of a variety of malignancies, including Burkitt's lymphoma, Hodgkin's disease and nasopharyngeal carcinoma (NPC). EBV+ lymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare type of intrahepatic cholangiocarcinoma with a distinct pathology and poorly understood treatment options. Morphologically, this neoplasm resembles undifferentiated NPC, a commonly EBV+ tumour with a prominent lymphoid infiltrate. Almost all of the current literature regarding LELCC describes early stage tumours that are treated surgically and achieve good outcomes. In contrast, this report documents a late stage LELCC treated unsuccessfully with systemic chemotherapy.


Assuntos
Carcinoma/patologia , Colangiocarcinoma/patologia , Infecções por Vírus Epstein-Barr/complicações , Adulto , Carcinoma/terapia , Carcinoma/virologia , Colangiocarcinoma/terapia , Colangiocarcinoma/virologia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/virologia , Evolução Fatal , Feminino , Hepatite B Crônica/diagnóstico , Herpesvirus Humano 4/metabolismo , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Linfadenopatia/patologia , Recidiva Local de Neoplasia , Neoplasias Retroperitoneais/diagnóstico por imagem
7.
Adv Respir Med ; 87(3): 175-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282559

RESUMO

INTRODUCTION: Diffusion weighted imaging (DWI) has shown its potential as a reliable noninvasive technique for tissue characterization. DWI reflects the tissue specific diffusion capacity which can be used for tissue characterization. Hypercellular tissue (e.g; malignant tumors) had restricted diffusion capacity with increased signals on DWI and low ADC values. Non-tumoral tissues show low cellularity, and diffusion capacity is not restricted resulting in signal loss on DWI and high apparent diffusion coefficient (ADC). Differential diagnosis of mediastinal lymphadenopathy is an issue of debate, especially in malignant benign differentiation. Diffusion weighted imaging with magnetic resonance could improve the diagnostic accuracy in differentiation between benign and malignant mediastinal nodes. OBJECTIVES: to determine the efficacy of diffusion weighted MRI in evaluation of mediastinal lymphadenopathy with histopathological correlation to differentiate benign from malignant lymph nodes. MATERIAL AND METHODS: 30 patients with mediastinal lymphadenopathy underwent diffusion weighted MRI. ADCs of lymph nodes were derived and constructed from b = 0 and b = 1000 sec/mm2 values by drawing regions of interests (ROI). Consequently, mediastinal nodes were studied, biopsies and histopathological analysis were done after MRI examination. RESULTS: The best cutoff point of ADC to differentiate benign from malignant lesions was 1.15 mm/sec (sensitivity 77%, specificity 92% and AUC 81.4%). Significant negative correlation of ADC by DW MRI and the size of the LNs. The mean ADC values in the lymphoma group was lower than in the sarcoidosis group, and the difference was statistically significant. CONCLUSION: The study supports that MRI with diffusion weighted images can differentiate benign from malignant mediastinal lymphadenopathy and differentiate lymphoma from sarcoidosis non-invasively.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Linfadenopatia/diagnóstico por imagem , Doenças Linfáticas/diagnóstico , Doenças do Mediastino/diagnóstico por imagem , Humanos , Linfonodos/patologia , Linfadenopatia/patologia , Doenças Linfáticas/patologia , Doenças do Mediastino/patologia , Sensibilidade e Especificidade
8.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300606

RESUMO

De Garengeot hernia describes a rare phenomenon in which a vermiform appendix is found in a femoral hernia sac. We describe a case of De Garengeot hernia presenting as a groin lump associated with loss of appetite, weight loss and fatigue. A 72-year-old woman was referred to our rapid access 2-week clinic as isolated lymphadenopathy with a 4-week history of a gradual right groin swelling accompanied by an unintentional weight loss, lethargy and anorexia. An urgent excisional lymph node biopsy was performed preceding the CT scan of the chest, abdomen and pelvis. The biopsy showed a shaving of appendix wall, and the CT scan revealed a right-sided femoral hernia with appendix as its content. The patient was urgently contacted for a laparoscopic appendicectomy and an open right femoral hernia repair. The patient recovered well postoperatively, and her systemic symptoms fully resolved when reviewed 10 weeks after the operation.


Assuntos
Apêndice/patologia , Virilha/patologia , Hérnia Femoral/diagnóstico , Linfadenopatia/patologia , Tomografia Computadorizada por Raios X , Idoso , Apendicectomia , Apêndice/diagnóstico por imagem , Fadiga , Feminino , Virilha/diagnóstico por imagem , Hérnia Femoral/cirurgia , Herniorrafia , Humanos , Doenças Raras , Resultado do Tratamento , Perda de Peso
9.
Infez Med ; 27(2): 190-193, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205045

RESUMO

The use of liquid silicone for cosmetic procedures can yield serious sequelae including embolization and pneumonia. We describe a recent case of silicone embolism syndrome occurring together with systemic tuberculosis in a transgendered patient newly diagnosed with AIDS. She presented with fever, hematochezia, lymphadenopathies, purple nodular lesions and lower limb edema. HIV test was positive. A chest X-Ray showed interstitial infiltrates and a tomography showed necrotic lymph nodes and pulmonary nodules with blurred borders, suggesting Kaposi sarcoma. Psychomotor impairment then occurred in the absence of tomographic signs of acute neurological events. The Mycobacterium tuberculosis genome was isolated from stool and bronchial washing samples. Histological examination of a necrotic lymph node showed lymphoadenopathy due to silicone accumulation. Moreover, the patient presented fever and swelling of lower limbs; a tomography showed multiple foreign body granulomas. After starting antitubercular, antiretroviral and antibiotic treatment she reported symptomatic improvement including a mild recovery of motor-slowing. There are few reports about silicone-induced pulmonary disease in HIV-1 infected patients and, as far as we know, none of them describes an overlapping pulmonary involvement due to Mycobacterium tuberculosis infection. Even if extensive clinical and radiologic evidence is suggestive of Kaposi sarcoma (fever, severe immunodeficiency, multiple cutaneous nodules, hematochezia, diffuse lymphoadenopathies), it is possible to see Kaposi-like manifestations in patients with systemic silicone embolization. With this article we wish to stress the attention on the possible overlap of more than one concurrent disease in an immunocompromised host.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Embolia/etiologia , Sarcoma de Kaposi/complicações , Géis de Silicone/efeitos adversos , Pessoas Transgênero , Tuberculose Miliar/complicações , Adulto , Feminino , Granuloma de Corpo Estranho/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Masculino , Mycobacterium tuberculosis/genética , Necrose , Sarcoma de Kaposi/diagnóstico por imagem
11.
Ticks Tick Borne Dis ; 10(5): 1142-1145, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31213411

RESUMO

BACKGROUND: Tick-borne rickettsioses are infectious diseases caused by obligate intracellular Gram-negative bacteria belonging to the spotted fever groupof Rickettsia. METHODS: We describe an unusual case of SENLAT (Scalp eschar and neck lymphadenopathy after tick bite), caused byRickettsia slovaca, associated with a cellulitis of the face in a 70-year-old woman, and diagnosed using qPCR on a scalp eschar swab. We review the literature regarding cases of SENLAT-associated-cellulitis and case of SENLAT diagnosed by qPCR on scalp eschar swabs. RESULTS: We found only one previous report of SENLAT associated with a cellulitis of the face. It was a nine-year-old French girl diagnosed by seroconversion for Rickettsia sp. Our review of the literature showed that qPCR on eschar swab samples is a less invasive method than performing cutaneous biopsy of the eschar and has good sensitivity and specificity (90% and 100%, respectively). CONCLUSIONS: We report the second case of cellulitis of the face associated with the SENLAT syndrome. Detection of Rickettsia by qPCR on swab sample of the scalp eschar is a simple, noninvasive technique allowing rapid diagnosis and treatment when SENLAT is suspected.


Assuntos
Celulite (Flegmão)/diagnóstico , Linfadenopatia/diagnóstico , Pescoço/patologia , Infecções por Rickettsia/diagnóstico , Rickettsia/isolamento & purificação , Couro Cabeludo/patologia , Idoso , Celulite (Flegmão)/microbiologia , Feminino , França , Humanos , Linfadenopatia/microbiologia , Linfadenopatia/patologia , Infecções por Rickettsia/microbiologia , Infecções por Rickettsia/patologia , Picadas de Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/patologia
12.
Neuroradiology ; 61(8): 897-910, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31175398

RESUMO

PURPOSE: To perform a systematic review and meta-analysis of literature comparing average apparent diffusion coefficient (ADC) for differentiating lymphomatous, metastatic, and non-malignant cervical lymphadenopathy. METHODS: We performed a comprehensive literature search of Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. Studies comparing average ADC of lymphomatous, metastatic, and non-malignant neck lymph nodes were included. The standardized mean difference and 95% confidence interval (CI) was calculated using random-effects models. In subgroup analysis of those studies applying ADC threshold for differentiation of cervical lymphadenopathy, pooled diagnostic odds ratio (DOR) and summary receiver operating characteristics (sROC) area under the curve (AUC) were determined. RESULTS: A total of 27 studies with 1165 patients were included, pooling data from 225 lymphomatous, 1162 metastatic, and 1333 non-malignant cervical lymph nodes. The average ADC values were lower in lymphomatous compared to metastatic nodes, and in metastatic compared to non-malignant nodes with a standardized mean difference of - 1.36 (95% CI: - 1.71 to - 1.01, p < 0.0001) and - 1.61 (95% CI: - 2.19 to - 1.04, p < 0.0001), respectively. In subgroup analysis, applying ADC threshold could differentiate lymphomatous from metastatic lymphadenopathy with DOR of 52.07 (95% CI 25.45-106.54) and sROC AUC of 0.936 (95% CI 0.896-0.979) and differentiate metastatic from non-malignant nodes with DOR of 39.45 (95% CI 16.92-92.18) and sROC AUC of 0.929 (95% CI 0.873-0.966). CONCLUSIONS: Quantitative assessment of ADC can help with differentiation of suspicious cervical lymph nodes, particularly in those patients without prior history of malignancy or unknown primary cancer site.


Assuntos
Imagem de Difusão por Ressonância Magnética , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Linfadenopatia/patologia , Metástase Linfática/patologia
13.
J Bronchology Interv Pulmonol ; 26(3): 199-209, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31238329

RESUMO

BACKGROUND: There is conflicting data on the utility of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) for the detection and subtyping of lymphomas. Herein, we present our experience with EBUS-TBNA in suspected lymphoma. METHODS: This was a multicenter retrospective study of subjects with suspected lymphoma who underwent EBUS-TBNA (July 2011 to June 2017). The performance characteristics of EBUS-TBNA were calculated separately for suspected new-onset and recurrent lymphoma as well as for subtyping. We also analyzed the factors predicting the yield of EBUS-TBNA in suspected lymphoma. RESULTS: Among the 4803 EBUS procedures performed, 92 (1.9%) subjects had either suspected or proven lymphoma; 48 were finally diagnosed to have lymphoma. The diagnostic sensitivities of EBUS-TBNA in new-onset and recurrent lymphomas were 72.7% and 73.3%, respectively. Only 24.2% (8/33) subjects with new-onset lymphoma could be appropriately subtyped. This low yield was possibly due to inadequate material for cell block in 10 subjects, and performance of immunophenotyping and flow cytometry in only 5 and 1 subjects, respectively. Among the suspected cases of recurrence, EBUS-TBNA was sufficient for management in 81.8% (18/22). On a multivariate analysis, no factor (rapid onsite evaluation, needle size, number of lymph nodes sampled, passes per node, and size of the largest lymph node sampled) predicted the diagnostic yield. CONCLUSION: EBUS-TBNA is a useful investigation in the diagnostic algorithm of suspected lymphoma as it helps avoid other invasive diagnostic procedures. The sensitivity of EBUS-TBNA in subtyping new-onset mediastinal lymphoma depends on the adequacy of cell aspirate and the judicious utilization of pathologic techniques.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Linfonodos/patologia , Linfadenopatia/diagnóstico , Linfoma/diagnóstico , Adulto , Broncoscopia , Feminino , Humanos , Linfadenopatia/patologia , Linfoma/patologia , Masculino , Mediastino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
14.
J Med Case Rep ; 13(1): 153, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113466

RESUMO

BACKGROUND: Primary plasmacytomas are localized proliferations of clonal plasma cells occurring in the absence of a systemic plasma cell dyscrasia such as multiple myeloma. Primary plasmacytomas most commonly manifest as solitary lesions of the bone or of the upper aerodigestive tract. Presentation in a lymph node is very uncommon and can often be initially mistaken for lymphoma. Because they are local phenomena, primary plasmacytomas are managed with local therapies such as radiation or, less commonly, excision. Multifocal presentations are rare and are often not amenable to local treatment modalities, thus requiring systemic therapies. Because of their rarity, standardized treatment guidelines are not established, and treatment paradigms borrow heavily from those employed in multiple myeloma. Multifocal presentation in lymph nodes is nearly unheard of with only seven such cases reported in the existing literature, only four of which were diffuse enough to require systemic therapy. Here we describe the most diffuse and widely distributed instance of primary lymph node plasmacytoma yet reported and present a description of its successful treatment with systemic therapy. CASE PRESENTATION: A 71-year-old Asian man presented with progressive fatigue in the setting of diffuse hypermetabolic lymphadenopathy throughout his chest, abdomen, and pelvis. A diagnosis of lymphoma was initially suspected; however, a lymph node biopsy was consistent with plasmacytoma. A bone marrow biopsy was unremarkable, and no monoclonal protein was identified, establishing a diagnosis of primary extramedullary plasmacytomas of the lymph nodes. He was treated with a myeloma-like regimen consisting of four cycles of bortezomib/dexamethasone followed by two cycles of thalidomide/prednisone with improvement in symptoms and near complete resolution of prior hypermetabolic lymphadenopathy. He remains in remission over 18 months following completion of therapy. CONCLUSION: This case report and accompanying literature review highlight the exceedingly rare and easily misclassified entity of primary plasmacytoma of diffuse lymph nodes. Importantly, we demonstrate that this entity may be treated with, and demonstrate excellent response to, systemic therapies often employed in multiple myeloma.


Assuntos
Bortezomib/uso terapêutico , Dexametasona/uso terapêutico , Linfonodos/patologia , Linfadenopatia/patologia , Plasmocitoma/patologia , Prednisona/uso terapêutico , Talidomida/uso terapêutico , Idoso , Fadiga , Humanos , Linfadenopatia/tratamento farmacológico , Masculino , Plasmócitos/patologia , Plasmocitoma/tratamento farmacológico , Indução de Remissão
15.
Int J Surg Pathol ; 27(7): 773-777, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31046495

RESUMO

Tattoo pigment migrates to regional lymph nodes, often causing acute or chronic lymphadenopathy. Past reports on tattoo lymphadenopathy are almost exclusively from Western countries. However, systemic distribution of tattoo pigment in lymph nodes has not been assessed in detail. In this article, we report a Japanese case of cervical adenocarcinoma, in which we successfully assessed the distribution of tattoo pigment deposition in pelvic and para-aortic lymph nodes. A 61-year-old woman with Japanese-style tattoos on both arms and her left thigh visited another clinic with postcoital bleeding. She was diagnosed with clinical stage 1B1 (cervical adenocarcinoma) and underwent radical hysterectomy and pelvic/para-aortic lymph node dissection. Histopathological examination revealed deposition of a black pigment in multiple lymph nodes. The pigment was more abundant in the left pelvic lymph nodes than in the para-aortic lymph nodes, a finding suggestive of pigment drainage from the tattoo on the left thigh. She remains free of disease more than 1 year after surgery. The diagnosis of tattoo lymphadenopathy is not easy when clinical information is lacking. The differential diagnoses include metastatic melanoma. Clinicians and pathologists should better recognize this phenomenon.


Assuntos
Adenocarcinoma/cirurgia , Corantes/efeitos adversos , Linfadenopatia/diagnóstico , Tatuagem/efeitos adversos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Braço , Diagnóstico Diferencial , Feminino , Humanos , Histerectomia , Japão , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Linfadenopatia/induzido quimicamente , Linfadenopatia/patologia , Metástase Linfática/diagnóstico , Melanoma/diagnóstico , Melanoma/secundário , Pessoa de Meia-Idade , Pelve , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Coxa da Perna , Neoplasias do Colo do Útero/patologia
17.
Pediatr Dermatol ; 36(4): e99-e101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132165

RESUMO

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7-year-old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Epilepsia Tipo Ausência/tratamento farmacológico , Etossuximida/efeitos adversos , Linfadenopatia/induzido quimicamente , Biópsia por Agulha , Criança , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/patologia , Eosinofilia/induzido quimicamente , Eosinofilia/fisiopatologia , Epilepsia Tipo Ausência/diagnóstico , Etossuximida/uso terapêutico , Seguimentos , Humanos , Imuno-Histoquímica , Linfadenopatia/patologia , Linfadenopatia/fisiopatologia , Masculino , Mediastino/patologia , Recidiva , Medição de Risco
18.
Medicine (Baltimore) ; 98(18): e15237, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045763

RESUMO

RATIONALE: Idiopathic multicentric Castleman disease (iMCD) is a systemic disease with multiple regions of lymphadenopathy and systemic symptoms and associated with rheumatoid arthritis (RA) and collagen diseases. However, few reported have described the coexistence of iMCD and RA and the mechanisms by which iMCD induces arthritis remain elusive. We experienced a rare case of iMCD, wherein the patient exhibited symptoms of polyarthritis with high-grade fever. PATIENT CONCERNS: A 34-year-old woman was admitted to our hospital for further evaluation of a high fever with polyarthritis. The levels of both rheumatoid factor and anticitrullinated protein antibody were negative. F-fluorodeoxyglucose/positron emission tomography-computed tomography showed lymphadenopathy with increased fluoro-2-deoxy-D-glucose uptake. Magnetic resonance imaging and musculoskeletal ultrasonography revealed active synovitis in the hands which was consistent with RA. DIAGNOSES: We diagnosed iMCD based on human herpesvirus 8 negativity, HIV negativity, systemic lymphadenopathy, and pathologic findings of the lymph nodes. The patient did not satisfy the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA. Cytokine assay showed elevated serum levels of interleukin-17 and CXCL10, comparable to those in patients with RA. INTERVENTIONS: We administered 15 mg/d of predonisolone. OUTCOMES: After this treatment, the patient's symptoms showed improvement. As of this writing, we tapered the prednisolone to 7.5 mg/d, and the patient's remission has been maintained for >4 months. LESSONS: The present case suggests that RA-like active synovitis may coexist in iMCD, resulting from aberrant T-cell activation and histologic examination using lymph node biopsy may help enable early diagnosis of iMCD.


Assuntos
Artrite Reumatoide/complicações , Hiperplasia do Linfonodo Gigante/complicações , Linfadenopatia/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Adulto , Artrite/diagnóstico , Artrite/etiologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/patologia , Hiperplasia do Linfonodo Gigante/sangue , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/patologia , Quimiocina CXCL10/sangue , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Febre/etiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Herpesvirus Humano 8 , Humanos , Interleucina-17/sangue , Linfadenopatia/patologia , Imagem por Ressonância Magnética/métodos , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Sinovite/patologia , Linfócitos T/patologia , Resultado do Tratamento
19.
J Bronchology Interv Pulmonol ; 26(3): 225-227, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30958394

RESUMO

BACKGROUND: Sarcoidosis is diagnosed by demonstration of granulomatous inflammation and exclusion of other potential causes. Lung parenchyma and intrathoracic lymph nodes are currently the commonest sites from which tissue is obtained in clinical practice, but historically scalene lymph node biopsy was the procedure of choice for diagnosing sarcoidosis in many institutions. AIM: We aimed to assess the utility of neck ultrasound (NUS) and cervical lymph node needle sampling among patients with stage 1 and 2 sarcoidosis. In addition, we analyzed the potential predictors of cervical lymphadenopathy in this retrospective cohort study. METHODS: Patients with evidence of intrathoracic lymphadenopathy and suspected sarcoidosis referred for an endobronchial ultrasound underwent NUS. Those with enlarged cervical lymph nodes underwent fine-needle aspiration and core needle biopsy when technically feasible. RESULTS: A total of 38 patients were included of which 34 (89.5%) underwent endobronchial ultrasound. Sixteen patients had enlarged lymph nodes on ultrasound and 8 (50%) of these underwent needle sampling. Non-necrotizing granulomas were detected in 6 cases (16.8%, 95% confidence interval, 6.1%-31.3%). Cervical lymphadenopathy was significantly associated with the presence of upper paratracheal lymphadenopathy (P=0.018) and the size of mediastinal lymph nodes on computed tomography (P=0.011). CONCLUSION: NUS and needle sampling of cervical lymph nodes is a potential modality that can be used for the diagnosis of sarcoidosis in a selected group of patients.


Assuntos
Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Sarcoidose/diagnóstico , Ultrassonografia , Adulto , Biópsia por Agulha Fina , Broncoscopia , Endossonografia , Feminino , Humanos , Linfadenopatia/etiologia , Masculino , Mediastino , Pessoa de Meia-Idade , Pescoço , Estudos Retrospectivos , Sarcoidose/complicações , Tomografia Computadorizada por Raios X
20.
Int J Radiat Oncol Biol Phys ; 104(5): 1017-1027, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30953712

RESUMO

PURPOSE: To identify adverse radiologic nodal features in cN+ TNM-8 stage I human papillomavirus-related (HPV+) oropharyngeal cancer (OPC). METHODS AND MATERIALS: All patients with HPV+ cT1-T2cN1 OPC treated with definitive intensity modulated radiation therapy from 2008 to 2015 were included. Radiologically involved lymph node number (LN), radiologic extranodal extension (rENE), retropharyngeal LN (RPLN), and lower neck (level 4 or 5b) LN involvement were assessed on pre-treatment computed tomography/magnetic resonance imaging by a specialized head and neck neuroradiologist. Disease-free survival (DFS), locoregional control, and distant control were compared between those with versus without rENE. Univariable and multivariable analysis with stepwise modal selection were applied to identify prognostic factors for DFS. RESULTS: A total of 45 rENE+ and 234 rENE- were identified. The rENE+ cohort had a higher number of LNs per patient (median: 6 vs 2, P < .001) and was more likely to have necrotic LNs (33 [73%] vs 132 [56%], P = .046). Median follow-up was 4.8 years. Although locoregional control was high in both cohorts (93% vs 97%, P = .34), the rENE+ group had inferior 5-year distant control (78% [59-88] vs 95% [91-97], P < .001) and DFS (58% [43-77] vs 90% [86-94], P < .001). In multivariable analysis, rENE+ (HR [hazard ratio] 4.3 [2.3-8.1], P < .001], T2 (vs T1) category (HR 2.1 [1.0-4.2], P = .039), smoking pack-years (HR 1.02 [1.0-1.03], P = .013), and the addition of systemic agents (HR 0.4 [0.2-0.8], P = .005) were prognostic for DFS. RPLN was prognostic for distant metastasis (HR 3.2, P = .013) but not for DFS after adjusting for rENE. CONCLUSIONS: Data from this contemporaneously treated cT1-T2N1 HPV+ OPC cohort suggest that the presence of rENE is an independent prognostic factor within stage I HPV+ OPC. RPLN is also associated with DM risk but not with DFS.


Assuntos
/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antineoplásicos/uso terapêutico , Tomografia Computadorizada de Feixe Cônico , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Ligamentos , Neoplasias Pulmonares/química , Neoplasias Pulmonares/secundário , Linfadenopatia/patologia , Linfadenopatia/virologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Necrose/diagnóstico por imagem , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/radioterapia , Prognóstico , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Resultado do Tratamento
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