PERIPHERAL LYMPH NODE EXCISIONAL BIOPSY IN CHILDREN: YIELD IN A TERTIARY CARE CENTRE

AIM: To study the pediatric patients in a developing country undergoing peripheral lymph node excision biopsy in terms of demographics and histopathological ndings and evaluate the diagnostic yield of peripheral Lymph node excision biopsy in children. MATERIALS AND METHODS: A retrospective study of 402 patients was done of the children undergoing peripheral lymph node st st excision biopsy in a tertiary care center from 1 January 2013 to 31 December 2018 (6 years). Demographics, histopathological ndings and yields were studied. RESULTS: Out of the 402 patients, 218 (54.2%) were males and 184(45.8%) were females. Male to female ratio 1.18: 1. Maximum patients belonged to the age group of 4-6years (26.87%) followed by the age group of 2-4years of age (22.89%). Most common group of nodes excised were cervical (77.9%) followed by axillary and inguinal lymph nodes (9.2%) each. The most common etiology was reactive lymphoid hyperplasia (63.18%) in our study followed by tuberculous lymphadenitis(31.84%). Specic ndings were seen in 35.58% and non-specic ndings were seen in 64.42% patients. Malignancy was seen in 8 patients (2%). CONCLUSION: Peripheral Lymphadenopathy in pediatric population is always a diagnostic challenge. While FNAC tends to be investigation of choice for adults, in a developing country with limited resources and high prevalence of tuberculosis, peripheral lymph node biopsy is the gold standard with a good diagnostic yield and should always be considered for patients with persistent lymphadenopathy. Clinical significance: The study highlights the importance of excision biopsy in peripheral lymphadenopathy in children in a developing nation with limited resources and high prevalence of infectious diseases.

Maternal schistosomiasis impairs offspring Interleukin-4 production and B cell expansion

Epidemiological studies have identified a correlation between maternal helminth infections and reduced immunity to some early childhood vaccinations, but the cellular basis for this is poorly understood. Here, we investigated the effects of maternal Schistosoma mansoni infection on steady-state offspring immunity, as well as immunity induced by a commercial tetanus/diphtheria vaccine using a dual IL-4 reporter mouse model of maternal schistosomiasis. We demonstrate that offspring born to S. mansoni infected mothers have reduced circulating plasma cells and peripheral lymph node follicular dendritic cells at steady state. These reductions correlate with reduced production of IL-4 by iNKT cells, the cellular source of IL-4 in the peripheral lymph node during early life. These defects in follicular dendritic cells and IL-4 production were maintained long-term with reduced secretion of IL-4 in the germinal center and reduced generation of TFH, memory B, and memory T cells in response to immunization with tetanus/diphtheria. Using single-cell RNASeq following tetanus/diphtheria immunization of offspring, we identified a defect in cell-cycle and cell-proliferation pathways in addition to a reduction in Ebf-1, a key B-cell transcription factor, in the majority of follicular B cells. These reductions are dependent on the presence of egg antigens in the mother, as offspring born to single-sex infected mothers do not have these transcriptional defects. These data indicate that maternal schistosomiasis leads to long-term defects in antigen-induced cellular immunity, and for the first time provide key mechanistic insight into the factors regulating reduced immunity in offspring born to S. mansoni infected mothers.

Induction of High Endothelial Venule–like Vessels in Oral and Cutaneous Lichen Planus: A Comparative Study

Lichen planus (LP) is a chronic inflammatory mucocutaneous disease involving the oral mucosa and skin. Both oral LP (OLP) and cutaneous LP (CLP) are histopathologically characterized by dense subepithelial lymphocyte infiltrates; however, the mechanisms underlying lymphocyte recruitment to sites of LP lesions are not fully understood. Here, we assessed the induction of peripheral lymph node addressin (PNAd)-expressing high endothelial venule (HEV)-like vessels in 19 OLP and 17 CLP cases. To do so, we performed immunohistochemical staining for PNAd and CD34, followed by quantitative analysis. We also conducted triple immunohistochemistry for PNAd and either CD3 and CD20 or CD4 and CD8 to identify the lymphocyte subset preferentially recruited via HEV-like vessels. PNAd-expressing HEV-like vessels were induced in and around lymphocyte aggregates in all cases of OLP and in 10 of 17 CLP cases, and these vessels were more frequently observed in OLP relative to CLP. Although the number of T-cells attached per HEV-like vessel exceeded the number of B-cells in both OLP and CLP, the number of CD4+ T-cells attached was greater than the number of CD8+ T-cells only in OLP. These findings combined suggest that PNAd-expressing HEV-like vessels play a more important role in the pathogenesis of OLP compared with CLP.

Surgical peripheral lymph node biopsies in Makurdi, Nigeria.

This study aims at determining the diagnostic value of peripheral lymph node biopsy and common causes of lymph node enlargement from biopsies obtained from patients with lymph-node enlargement at different sites in a teaching hospital in north central Nigeria town of Makurdi, Benue State. This is a retrospective study of surgical peripheral lymph node biopsies received in the department of Anatomic Pathology, Benue State University Teaching Hospital, Makurdi, Nigeria from February, 2012 to September, 2019. Total number of lymph node biopsies during the period was 47 representing 1.0% of surgical pathology specimens submitted to the department; 25 cases were females and 22 were males. Metastatic nodal involvement (57%), lymphoma (23%) and tuberculosis lymphadenitis (11%) were the most common causes of lymph node enlargement. All the studied nodes were localized. The most common sites of lymphadenopathy were axillary (21%), cervical (16%) and Inguinal (6%). While axillary lymph node enlargements were mostly associated with tumor metastasis, cervical and inguinal node enlargements were mostly associated with tuberculosis and lymphoma, respectively. Surgical excision of nodal enlargement for histological examination represents a simple, good diagnostic yield with lack of significant morbidity or mortality.