Importance of fine needle aspiration cytology in revealing the spectrum of axillary swelling: An experience with 30 cases

FNAC plays an important role in the early diagnosis of the axillary swelling. This study was conducted to document the spectrum of lesions on the patients that came for FNAC with the complain of axillary swelling. Present study was carried out at the Department of Pathology. A total of 30 cases of axillary swelling which were referred for FNAC in the department of Pathology, over the period of 3 months were retrospectively evaluated. All the stained slides of the cases were also reviewed.: From 30 cases there were 13 males and 17 females. On examining the stained slides maximum number of cases presented with chronic granulomatous lymphadenitis followed by Reactive lymphadenitis , Lipoma, Ductal carcinoma metastasis of breast in axillary lymphnode, chronic non-specific lymphadenitis, One unusual case of Hydatid cyst who presenting with axillary swelling was also diagnosed. : FNAC is an important tool in differentiating benign and malignant lesions thus, helps in the proper management of the disease.

STUDY OF LYMPH NODE CYTOLOGY IN HIV INFECTED PATIENTS

Background and Aim: Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. This study was performed to evaluate the role of FNAC as a cytological investigative tool in the diagnosis of various lesions in HIV lymphadenopathy. Material and Methods: This study was carried out in Tertiary care Institute of India, over a period of one year. Total 50 cases of HIV lymphadenopathy patients were participated in the study after having signed the Informed Consent Form. Diagnosis of HIV was done by enzyme linked immunosorbant assay (ELISA) test, followed by the CD4 counts by BD FACS Count system in HIV positive patients. FNAC procedure was performed as an OPD procedure in cytology OPD of pathology department. Results: Most common site of HIV lymphadenopathy is cervical lymph node 40 (80%), followed by supraclavicular 6(12%) followed by axillary lymph node 4(8%). The most common lesion found was mycobacterial infection 22(44%), followed by reactive lymphadenitis 15(30%). Non-specific chronic granulomatous lymphadenitis in 10(22%) and 3(6%) cases of acute suppurative lymphadenitis. CD4 count more than 500 cells/ µL was seen in 9 (18%) cases of reactive lymphadenitis and 4 (8%) cases of chronic granulomatous lymphadenitis. Patients with tubercular infection had CD4 count between 200- 499 cells/ µL in 12 (24%) cases and less than 200 in 10 (20%) cases. Conclusion: FNAC is relatively inexpensive and valuable tool for identification of opportunistic infections, neoplastic lesions and non-neoplastic lesions. It may spare patients lymph node excision and enable immediate treatment of specific infection. This procedure is readily repeatable and can be used for follow up during and after treatment. Keywords: Human immunodeficiency virus, lymphadenopathy, Non-specific chronic granulomatous lymphadenitis, tuberculosis

Spectrum of different pathologies in cytology coming to a tertiary care centre: an experience over one-year duration

Background: The aim of the study was to study the pattern of pathologies identified on Fine needle aspiration (FNA) in a tertiary hospital in Dhanbad, Jharkhand during the period July 2020 to July 2021, as well as to identify the profile of patients undergoing the procedure at our hospital.Methods: The data pertaining to the details of the patients who underwent FNA evaluation from the period July 2020 to July 2021 at a tertiary hospital located in Dhanbad, Jharkhand, was analysed to determine the age and sex distribution of the patients and the distribution of pathologies diagnosed on FNA.Results: The female gender was predominant (54%; 64 out of 118 patients) among the patients who underwent FNAC. A majority of the patients were in the age group of 20 to 50 years. Lymph node aspiration (reactive and granulomatous lymphadenitis) was predominant in our series (40%; 47 cases out of 118 FNA evaluations). Lipoma was the third most common diagnosis (12.7%; 15 out of 118 FNA evaluations).Conclusions: FNA evaluation is a quick, easy, relatively non-traumatic, and, in expert hands, a reliable method of diagnosing the pathology. Reactive lymph node hyperplasia granulomatous lymphadenitis and lipoma were three most common cases in our series.

Mycobacterium bovis detection in slaughtered pigs in the state of Rio Grande do Sul, Brazil

The infection by the Mycobacterium genus is important in pig farming due to the economic losses caused by total or partial carcass condemnation in slaughterhouses. The present study investigated the occurrence of a tuberculosis outbreak in pigs, based on the identification of lesions at the slaughter line of a slaughterhouse. At the inspection line of the slaughterhouse, carcasses were identified with viscera containing macroscopic lesions that indicated tuberculosis (granulomatous lymphadenitis). Tracheobronchial, mesenteric, and submandibular lymph nodes were collected, as well as liver samples and their corresponding lymph nodes. The samples were sent to the Federal Agricultural Defense Laboratory (LFDA/RS) and processed for the diagnosis of tuberculosis and the molecular characterization of Mycobacterium bovis. Based on the results of post-mortem and laboratory inspections, the occurrence was characterized as a tuberculosis outbreak in pigs, which originated from a farm in the state of Rio Grande do Sul, Brazil. Over three months, three batches, adding up to 2884 animals, were sent to slaughter, of which 102 (3.5%) had tuberculosis-like lesions at the inspection line. Based on these results, the productive process was investigated, assessing the feeding, water supply, and milk whey offered in the diet of pigs. It was concluded that the outbreak was caused by feeding unpasteurized or inadequately pasteurized (insufficient time x temperature relation) whey to the pigs. The use of whey from cheese production is a frequent practice in the state of Rio Grande do Sul and one of the risk factors for granulomatous lymphadenitis in pigs.

Disseminated Salmonellosis in a child with IL12Rß1 deficiency – Case report and review of literature.

Mendelian susceptibility to mycobacterial disease (MSMD) is a group of genetic disorders characterized by a defect in interferon γ (IFN γ)–mediated immunity, with predisposition to infections caused by atypical and low virulent mycobacteria and other intra-macrophagic organisms like Salmonella, Klebsiella, Listeria etc. A 10-year-old boy, second born of a consanguineously (third-degree) married Indian couple, presented with left inguinal and submandibular lymphadenopathy with low grade fever for 10 days. Past history was significant as the child had been unwell from infancy. At the age of 4 months and 5 years, he was diagnosed to have tubercular axillary lymphadenitis and was treated with anti-tubercular drugs on each occasion and he responded to the same. On examination, he had left submandibular and inguinal lymphadenopathy and mild splenomegaly. Chest radiograph showed enlarged mediastinal nodes. He underwent left inguinal lymph node biopsy that reported granulomatous lymphadenitis. However, culture from the biopsy showed a growth of Salmonella enterica sensitive to ceftriaxone. Genetic evaluation showed pathogenic homozygous mutation c.1791 + 2T > G in exon 15 of IL12Rß1 gene by whole exome sequencing. A diagnosis of Mendelian Susceptibility to Mycobacterial Disease (MSMD) was established and he was treated with intravenous ceftriaxone followed by oral cefixime. He responded promptly and lymphadenopathy resolved. He is currently being maintained on azithromycin prophylaxis. Children and adults presenting with disseminated infections with atypical mycobacteria and salmonella must be evaluated for MSMD. Disseminated salmonellosis is a peculiar manifestation in IL12Rß1 deficiency. A detailed review of literature on IL12RB1 deficiency was performed. Index case has been discussed in light of the previously published literature.

Complete resolution of juvenile neuropsychiatric lupus with low dose rituximab

Nervous system involvement leads to high mortality in juvenile systemic lupus erythematosus. We present the case of a 12-year-old girl who was admitted with a history of recurrence of fever, cervical swellings, seizure, and delirium. Approximately 6 months back, she was started on antitubercular therapy (ATT) for fever and granulomatous lymphadenitis. She developed a recurrence of fever, new cervical swellings, seizures, and delirium while she was continuing ATT. Magnetic Resonance Imaging brain revealed multiple hyperintensities in bilateral basal ganglia, temporal, and hippocampal regions. The patient was diagnosed to have lupus based on clinical features, positive antinuclear antibody, positive double-stranded DNA antibody, and hypocomplementemia. To avoid cyclophosphamide-related gonadotoxicity in this young girl, Rituximab was given. She was treated with two doses of Rituximab and there was complete resolution of her neuropsychiatric SLE. Rituximab can be considered over cyclophosphamide in children to avoid gonadotoxicity.

Aseptic meningitis and hydrocephalus secondary to neurosarcoidosis

A 53-year-old woman presented to hospital with gait instability, urinary incontinence and confusion. She had a 4-month history of headache, blurred vision, personality change and memory problems. Magnetic Resonance Imaging of the brain after contrast application showed tectal plate and occipital enhancement, as well as a known hydrocephalus. Cerebrospinal fluid showed aseptic meningitis with no evidence of clonal expansion. After further imaging that showed generalised lymphadenopathy and subsequent tissue biopsy that showed granulomatous lymphadenitis, she was diagnosed with neurosarcoidosis. She was treated with steroids which resulted in immediate cognitive and motor improvements as well as resolution of her urinary incontinence. We discuss the features of this case that pointed towards neoplastic, infective and other autoimmune aetiologies. We describe how they were excluded and provide the rationale for our treatment. This case demonstrates an important sequela sarcoidosis, and we conclude by recommending a multidisciplinary approach towards its diagnosis and management.

Granulomatous and sarcoid-like immune related adverse events (irAEs) in melanoma patients following CTLA4 blockade adjuvant therapy: An analysis of 1670 high-risk patients.

9582 Background: Granulomatous and sarcoid-like lesions (GSL) affecting the skin, lungs, thoracic lymph nodes, eyes and other organs following treatment with immune checkpoint inhibitors (ICIs) have been described in sporadic reports in the literature but the true incidence is unknown. Methods: We sought to estimate the incidence of GSL in the context of prospectively conducted ECOG-ACRIN E1609 phase III adjuvant trial in high-risk resected melanoma (N=1670 patients) testing ipilimumab 3 mg/kg (ipi3) and 10 mg/kg (ipi10) versus high-dose interferon-α (HDI). Descriptive statistics were used to calculate the incidence. Results: Among 1670 total patients treated with ICIs or with HDI in E1609, 1034 were treated with ipilimumab and 636 with HDI. Six GSL cases were reported among 1670 total patients treated with ipilimumab or with HDI as summarized in the table along with the corresponding CTCAE grades. More cases were observed with ipi10, followed by ipi3 and HDI, respectively. Organs involved included skin and subcutaneous tissue (granuloma annulare, granulomatous dermatitis), eye (ocular sarcoidosis), lymph nodes (noncaseating granulomatous lymphadenitis), lung and mediastinal lymph nodes (sarcoidosis, granulomatous inflammation). Conclusions: The incidence of granulomatous and sarcoid-like lesions (GSL) with adjuvant ipilimumab therapy in high-risk melanoma is rare. Reported cases ranged in grade from 1-3 and appeared manageable. Since most cases are asymptomatic, it is possible that GSLs are under-recognized and therefore, under-reported. A larger analysis including patients treated with anti-PD1 antibodies is currently underway. Clinical trial information: NCT01274338. [Table: see text]

Clinical and ultrasound characteristics of pediatric lateral neck masses

Lateral neck masses (LNM) often present a diagnostic challenge in the practice of pediatric plastic surgeon. The aim of this study is to investigate the clinical and ultrasound (US) characteristics of pediatric LNM in order to make mutual comparison between their entities and enable the most accurate preoperative diagnosis. A cross-sectional study was conducted among 250 pediatric patients treated by surgical excision or sclerotherapy in our institution in the period from July 2009 to June 2019. Lymphatic malformation was the most frequent congenital LNM (60.9%), while reactive or granulomatous lymphadenitis was the most frequent acquired LNM (47%). Congenital anomalies were significantly more often localized in the upper half of the sternocleidomastoid (SCM) muscle region, and had more often soft consistency than acquired ones. Congenital LNM had a 32.37 (3.44–304.63) times higher likelihood of incorrect (p = 0.002) and 5.86 (1.35–25.48) times higher likelihood of undetermined (p = 0.018) than correct US findings, respectively. Acquired LNM were significantly more often localized in the region behind the SCM muscle and more often had solid US appearance in comparison to the congenital ones. Association of the clinical and US findings is very important in determining the most accurate preoperative diagnosis without exposing the children to unnecessary utilizing ionizing radiation or anesthesia. Although they are mostly benign, extreme caution is necessary due to malignancies which were found in 16.4% of all our patients.