• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4677-4681
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• 2014

Background: This study aimed to characterize the histopathological pattern of lymph node pathology among Saudi patients and to highlight the age and gender variations of these lesions as base line data. Materials and Methods: We retrospectively analyzed the data from lymph node biopsy specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Results: Of the 289 lymph node biopsy specimens received, 154 (53.3%) were from males and 135 (46.7%) from females giving a male: female ratio of 1.14:1. Age of the patients ranged from 2.5 to 96 years with a mean age 33.9 years. The commonest lymph node group affected was the cervical (30.4%) followed by axillary (9.7%) and inguinal (8.7%). Malignant lymphoma [71 Hodgkin's disease (HD), 57 non Hodgkin's lymphoma (NHL)] 128 (44.3%), reactive hyperplasia 68 (23.5%), and tuberculosis 41 (14.2%) were the common causes of lymph node enlargement. While HD, reactive hyperplasia and tuberculosis were commonest in young adult patients (10-29 years old) and rare above the age of 50 years; NHL was the predominant cause of lymph node enlargement above 50 years. Conclusions: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.3%) followed by non-specific reactive hyperplasia (23.5%) and tuberculous lymphadenitis (14.2%).

• IMMUNE NETWORK
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• v.14 no.6
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• pp.307-320
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• 2014

Mycobacterium scrofulaceum is an environmental and slow-growing atypical mycobacterium. Emerging evidence suggests that M. scrofulaceum infection is associated with cervical lymphadenitis in children and pulmonary or systemic infections in immunocompromised adults. However, the nature of host innate immune responses to M. scrofulaceum remains unclear. In this study, we examined the innate immune responses in murine bone marrow-derived macrophages (BMDMs) infected with different M. scrofulaceum strains including ATCC type strains and two clinically isolated strains (rough and smooth types). All three strains resulted in the production of proinflammatory cytokines in BMDMs mediated through toll-like receptor-2 and the adaptor MyD88. Activation of MAPKs (extracellular signal-regulated kinase 1/2, and p38, and c-Jun N-terminal kinase) and nuclear receptor (NF)-${\kappa}B$ together with intracellular reactive oxygen species generation were required for the expression of proinflammatory cytokines in BMDMs. In addition, the rough morphotypes of M. scrofulaceum clinical strains induced higher levels of proinflammatory cytokines, MAPK and NF-${\kappa}B$ activation, and ROS production than other strains. When mice were infected with different M. scrofulaceum strains, those infected with the rough strain showed the greatest hepatosplenomegaly, granulomatous lesions, and immune cell infiltration in the lungs. Notably, the bacterial load was higher in mice infected with rough colonies than in mice infected with ATCC or smooth strains. Collectively, these data indicate that rough M. scrofulaceum induces higher inflammatory responses and virulence than ATCC or smooth strains.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.102-107
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• 2000

Monocytoid B-cell lymphoma is uncommon, low grade lymphoma originating from monocytoid B lymphocytes. Monocytoid B-cell lymphoma usually presents as a localized lymphadenopathy. Peripheral lymph nodes are most often involved, particularly those in the frequent in the head and neck area. A distinctive feature is the association of monocytoid B-cell lymphoma with autoimmune diseases. Sjogren Syndrome had been present in 22% of patient with monocytoid lymphoma. Extranodal involvement by monocytoid lymphoma was reported in the salivary gland, breast, thyroid, and stomach. There were also occasional extensions to the liver and retroperitoneum. The bone marrow and peripheral blood involvement by monocytoid lymphoma is very rare, which is frequently seen in hairly cell leukemia. Fever, weight loss, and other constitutional signs are usually absent. Most patients have no symptoms, and the only sign is enlarged lymph nodes. The clinical course remains indolent; most patients are in complete remission and recurrence with progression to a high-grade lymphoma of large cell type was recorded only in a few cases. Authors experienced a case of monocytoid B-cell lymphoma associated with Sjogren Syndrome mistaken to simple cervical lymphadenitis in a 60-year-old female. We report this case with a review of literatures.

• Pediatric Infection and Vaccine
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• v.26 no.3
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• pp.179-187
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• 2019

Purpose: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is a leading cause of periodic fever in children. This study describes the clinical characteristics of PFAPA syndrome in patients from a single center. Methods: Thirteen children diagnosed with PFAPA syndrome at Seoul National University Children's Hospital were included in this study. Retrospective medical chart reviews were performed. Results: Among the 13 patients, 8 (61.5%) were male. The median follow-up duration was 3.3 years (range, 10 months-8.3 years). The median age of periodic fever onset was 3 years (range, 1-6 years). All patients had at least 5 episodes of periodic fever and pharyngitis, managed with oral antibiotics, before diagnosis. The median occurrence of fever was every 3.9 weeks and lasted for 4.2 days. All patients had pharyngitis and 12 (92.3%) had cervical lymphadenitis. Blood tests were performed for 12 patients, and no patients had neutropenia. Both the C-reactive protein and erythrocyte sedimentation rate were elevated at medians of 4.5 mg/dL (range, 0.4-13.2 mg/dL) and 29 mm/hr (range, 16-49 mm/hr), respectively. Throat swab cultures and rapid streptococcal antigen tests were negative. Nine (69.2%) patients received oral prednisolone at a median dose of 0.8 mg/kg, and in 6 (66.7%) patients, fever resolved within a few hours. Three (23.1%) patients received tonsillectomy and adenoidectomy. Conclusions: PFAPA syndrome should be considered when a child presents with periodic fever along with aphthous stomatitis, pharyngitis, or cervical lymphadenitis. Glucocorticoid administration is effective for fever resolution and can reduce unnecessary use of antibiotics.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1368-1372
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• 2002

Purpose : Group A streptococci have a cell wall which consists of M protein and T protein. T protein is known to be helpful in the understanding of the epidemiology of group A streptococci. To study the epidemiologic characteristics, we serotyped T protein of group A streptococci obtained from patients admitted to hospitals, or who visited OPD in five districts of Seoul the during last three years. Methods : Group A streptococci were obtained in five districts in north, northeast, central, northwest and south Seoul from 1998 through 2000. All isolated group A streptococci were serotyped with T protein antisera(Institute of Sera and Vaccine, Prague, Czech Republic). Results : In 1998, analysis of obtained total number of 92 strains revealed that T12, T4, and NT acounted for 72.2%. Among seven cases of scarlet fever, T12 was isolated in four cases and T4 was found in three cases. Two cases of tonsilar abscess produced T8 and NT. One case of cervical lymphadenitis showed T12. In 1999, 41 cases were studied showing that T12, T4, and T1 contributed 68%. Among five cases of scarlet fever, T12 and T4 make up three case. There were two cases of pneumonia(T4 and T1) and one case of cervical lymphadenitis(T8/25). In 2000, the study was performed in four districts except the central area. Among 83 isolates, T12, T4 and T1 accounted for 63.9%. There were three cases of scarlet fever(T12, T4, T5), one case of tonsillar abscess(T12), one case of pneumonia(NT) and one case of sepsis(T1). Conclusion : Serological analysis of T protein of group A streptococci shows no endemic specificity. The yearly pattern reveals that T12 had been decreasing but T1 had shown the opposite trend.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.481-491
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• 1995

Background: Recently there has been a trend of an increasing incidence of mediastinal tuberculous lymphadenitis(MTL) in adults. MTL often cause bronchial stenosis or esophago-mediastinal fistula. In spite of effective treatment, it is difficult to cure. Moreover, relapse frequently occurs. Authors analyzed chest CT findings and clinical features of 29 cases with MTL Methods: 29 cases with MTL were retrospectively studied with the clinical and radiologic features from April 1990 to March 1995 Results: 1) A total of 29 cases were studied. 12 cases were male and 17 cases were female. The male to female ratio was 1:1.4 Mean age was 29 years old. The 3rd decade(45%) was the most prevalent age group 2) The most common presenting symptoms and signs were palpable neck masses(62%) followed by cough(59%) and sputum(38%) 3) Except in one case of MTL, all patients had coexisting pulmonary tuberculosis, cervical tuberculous lymphadenitis, endobronchial tuberculosis and tuberculous pleurisy. Among the coexisting tuberculous diseases, Pulmonary tuberculosis was the most common(76%) 4) On simple chest X-ray, mediastinal enlargement was noted in 21 cases(72%), but it was not noted in 8 cases(28%). The most frequently involving site was the paratracheal node in 16 cases(72%). Rt side predominence(73%) was noted 5) Patterns of node appearance on a postcontrast CT scan were classified into 3 types. There were 19 cases(30%) of the Homogenous type, 30 cases(47%) of the Central low density type and 15 cases(23%) of the Peripheral fat obliteration type. The most common type was the central low density type. The most common lymph node size was 1~2 cm(88%) 6) The most frequently involved site was the paratracheal node in 26 cases(89%) by chest CT. Rt side(63%) was predominant 7) 9 cases(43%) had complete therapy and most common treatment duration was 13 - 18 months. 12 cases(57%) had incomplete continuing antituberculous medication and half of the cases had been treated above 19 months. Conclusion: Chest CT findings of MTL showed central low density area and peripheral rim enhancement, so this characteristic findings could differentiate it from other mediastinal diseases and help a diagnosis of tuberculosis. In spite of effective antituberculous medication, it is difficult to cure. Moreover, relapse frequently occurs. Further studies will be needed of the clinical features and the treatment of MTL.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.523-531
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• 2006

Background : Cervical tuberculous lymphadenopathy is a very common disease with a similar incidence to pulmonary tuberculosis. Dendritic cells play a role of initial antigen presentation of this illness. Nevertheless, the precise role of these antigen-presenting cells according to the clinical features in unclear. The aim of this study was to determine the clinical implication of dendritic cell infiltration in the cervical lymph nodes. Methods : A review of the clinical characteristics was carried out retrospectively based on the clinical records and radiography. Immunohistochemical staining was performed on the available histology specimens of 72 cases using the S-100b polyclonal antibody for dendritic cells. The number of dendritic cells with tuberculous granuloma were determined. A $X^2$ test, unpaired T test and multiple logistic regression analysis were performed. Results : Thirty percent of subjects had previous or concurrent pulmonary TB. Twenty one percent of cases showed a positive reaction on the AFB stain. Within a granuloma, the number of infiltrated dendritic cells was $113.0{\pm}7.0$. The incidence of fever and cough decreased with increasing infiltration of dendritic cells Multivariate regression analysis showed that the infiltration of dendritic cells could significantly contribute to fever. Conclusion : Overall, dendritic cells can control a Mycobacterium tuberculosis infection and modulate the immune response, as well as resolve the clinical manifestations of TB lymphadenopathy.

• Journal of Physiology & Pathology in Korean Medicine
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• v.24 no.2
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• pp.310-318
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• 2010

Dioscorea bulbifera is one of the traditional medicinal herb. It commonly used in the treatment of hematemesis, epistaxis, tuberculous cervical lymphadenitis, laryngitis, acute infectious disease in East Asia. In the present study, we have demonstrated the anti-inflammatory effects of Dioscorea bulbifera MeOH extract (DBME) in macrophage cell line. To investigate mechanism of the anti-inflammatory activity, we examined the effects of the lipopolysaccaride (LPS)-induced production of nitric oxide (NO), prostaglandin $E_2$ ($PGE_2$), pro-inflammatory cytokines and expression of inducible NO synthase (iNOS), cyclooxygenase-2 (COX-2), p-inhibitory ${\kappa}B{\alpha}$ (p-$I{\kappa}B{\alpha}$), and nuclear factor-${\kappa}B$ (NF-${\kappa}B$) in a murine macrophage cell line RAW 264.7. The RAW 264.7 cells were cultured in DMEM + serum medium for 24 hrs. After serum starvation for 24 hrs, the cells were treated with DBME 0.03, 0.10, 0.30 mg/$m{\ell}$ for 1 h, followed by stimulation with LPS (1 ${\mu}g/m{\ell}$) for activation of immune response. After treatment, cell viability was measured by MTT assay, and NO production was monitored by measuring the nitrite content in culture medium. The protein band of iNOS, COX-2, p-$I{\kappa}B{\alpha}$, and NF-${\kappa}B$ was determined by immunoblot analysis and levels of cytokine were analyzed by sandwich immunoassays. There were three experimental groups: carrageenan, DBME 0.3, 1.0 g/kg. Rats were administrated either carrageenan (40% PEG) or carrageenan + DBME (0.3, 1.0 g/kg body weight) for 4 days (p.o.). To induce acute paw edema, rats were injected 1% carrageenan (100 ${\mu}{\ell}$/rat, dissolved in sterilized saline). The effect of DBME in the carrageenan-induced rat paw edema. As results, DBME has an inhibitory effect on the production of NO, PGE2, TNF-${\alpha}$, IL-$1{\beta}$ and IL-6 and on the expression of iNOS, COX-2, p-$I{\kappa}B{\alpha}$ and translocation of NF-${\kappa}B$ to nuclear from cytosol. In addition, DBME effectively inhibited the increases of paw edema induced by carrageenan treatment in vivo. These results suggest that DBME can inhibit production of pro-inflammatory mediators and might be a useful source for treatment of acute inflammatory disease.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.206-212
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• 2001

Objective : To determine the clinical and bacteriologic efficacy and safety of Cefprozil in acute pharyngitis and pharyngotonsilitis caused by Group A beta hemolytic streptococci in pediatric patients. Methods : Any patient of 3 to 14 age who visited the hospitals enrolled in this study with the signs and symptoms of pharyngitis or pharyngotonsilitis since July, 2000 to March, 2001, was taken throat culture and given Cefprozil(15 mg/kg/day, in two divided doses) for 10 days. 138 patients of whom showed positive culture results were followed up for the signs and symptoms during the treatment to determine clinical efficacy. Any undesirable effect was reported to determine the safety of the drug. Follow up cultures were done at the end of the study and bacteriologic efficacy was determined. Results : 138 of 256 patients who visited the hospitals with the signs and symptoms of pharyngitis or pharyngotonsilitis showed positive growth on throat culture. Mean age of the patients was $6.1{\pm}2.5$ and males and females were equally numbered. 129 of them complained fever on the first visit and 112(86.6%) of them were improved at the end of the study. Cervical lymphadenitis was seen in 58 patients and 44(75.9%) of them improved at the end of the study. Exudative pharyngitis was seen in 96 patients and 81(84.3%) of them improved. The overall clinical effcacy based on this results showed that 110(79.7%) of the patients were cured and 17(12.3%) of them improved. On the cultures and bacteriologic efficacy, 24.6% of them showed documented eradication after treatment and 62.3% of them showed presumptive eradication. Sensitivity test was done by agar dilution method and Cefprozil showed 100% sensitivity. Erythromycin, Clarithromycin and azithromycin showed 87%, 85.6 %, 90.6% sensitivity, respectively. Conclusion : Cefprozil is proved to be effective in controlling group A streptococcal pharyngitis and pharyngotonsilitis in children and showed good sensitivity. Cefprozil can be used as an effective oral cephalosporin in the patients showing penicillin hypersensitivity or patients who other drugs have failed.

• Clinical and Experimental Pediatrics
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• v.48 no.8
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• pp.839-845
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• 2005

Purpose : Neck masses, in pediatric population, derive from a multitude of congenital, inflammatory, or neoplastic diseases. The majority of these masses represent benign conditions. However, thorough clinical evaluation is required to rule out malignant diseases. We evaluated the causes, clinical characteristics and outcomes of children with neck masses who underwent tissue biopsy. Methods : A total of 28 medical records of children with neck mass who underwent tissue biopsy at Chungnam National University Hospital, from January 2000 to March 2004 were retrospectively analyzed. The methods of biopsy were ultrasonography guided core biopsy(CB), fine needle aspiration biopsy(FNAB) and excisional biopsy. Results : Out of 28 patients, half were boys. The most common location of the mass was the posterior cervical area(N=19, 67.9%). Laboratory findings of peripheral blood and serologic studies were nonspecific. In 25(89.3%) cases, CB or FNAB was initially performed for neck masses. Among them 10 cases(40%) were reactive hyperplasia, 8(32%) inflammatory granulation tissues, 4(16%) necrotizing lymphadenitis, and 3(12%) acute suppurative inflammations. Initially, excisional biopsy was performed for diagnosis in 3(10.7%) cases. Diagnosis of these cases was thyroglossal duct cyst, dermoid cyst and lymphoblastic lymphoma, respectively. Conclusion : Most neck masses in children were benign. CB and FNAB were safe methods for tissue sampling, without need for general anesthesia.