• Korean Journal of Radiology
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• v.2 no.3
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• pp.138-144
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• 2001

Objective: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. Materials and Methods: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. Results: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). Conclusion: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.

• Korean Journal of Bronchoesophagology
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• v.8 no.1
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• pp.50-56
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• 2002

Advanced or recurrent thyroid cancer, and metastatic paratracheal lymph nodes may directly invade the trachea and lead to tracheal stenosis. In these cases the stenosis is not circumferential and it would be possible to reconstruct the trachea after partial resection of the stenotic trachea. We experienced five cases of tracheal reconstruction after partial resection of the tracheal wall in four Patients of advanced thyroid cancer, and in one Patient of malignant paratracheal lymphadenopathy.

• Korean Journal of Radiology
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• v.1 no.2
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• pp.114-117
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• 2000

Disseminated mycobacterial infection after bacillus Calmette-Guerin (BCG) vaccination is a very rare disorder, occurring mostly in patients with immunologic deficiency. We report a case of disseminated BCG infection in a 16-month-old girl with severe combined immunodeficiency. Plain radiographs showed multiple osteolytic lesions in the femora, tibiae, humerus, and phalanges. Abdominal sonography and CT scanning revealed multiple nodules in the spleen, and portocaval lymphadenopathy.

• Biomedical Science Letters
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• v.19 no.2
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• pp.153-157
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• 2013

Although culture is the gold standard method to identify mycobacteria, its use in tuberculous lymphadenitis (TBL) is limited due to formalin fixation of the submitted specimens. We evaluated the performance of quantitative real-time PCR (q-PCR) for Mycobacterium Tuberculosis (MTB) in granulomatous lymphadenitis using formalin-fixed paraffin-embedded (FFPE) tissues. From 2000 to 2010, a total number of 117 cases of lymph node samples with granulomatous inflammation which were surgically removed and fixed in formalin were studied. Hematoxylin & Eosin (H&E) and Ziehl-Neelsen-stained (ZN) slides were reviewed. qPCR using Real TB-Taq$^{(R)}$ was performed for all cases to identify Mycobacterium tuberculosis. Thirteen non-tuberculous lymphadenopathy cases were used as negative control. Cervical lymph nodes were more frequently affected (60%, 70/117) than other sites. ZN stain for acid fast bacilli was positive in 19 (16.24%) cases. qPCR for tuberculosis was positive in 92 (78.63%) cases. Caseous necrosis was found in 103 (88.03%) cases. While the ZN stain and qPCR were both negative in all control cases, the qPCR showed a significantly higher positive rate (78.63% vs. 16.24%) compared to ZN stain in histologically diagnosed TBL. Quantitative real-time PCR proves to be more sensitive than ZN stain for diagnosis of tuberculous lymphadenitis.

• The Korean Journal of Cytopathology
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• v.8 no.1
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• pp.11-19
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• 1997

Clinical lymphadenopathies are subjected to fine needle aspiration cytology(FNAC) for diagnosing not only benign lesions but also malignant ones, as the first diagnostic procedure. While the diagnostic reliability in metastatic carcinoma is high, it is difficult to differentiate malignant lymphoma from reactive conditions. We evaluated the diagnostic reliability of FNAC in lymphadenopathy, and discuss the diagnostic limitation and its place in clinical practice in this study, Over 8 years from January 1988, FNAC of 1,216 lymphadenopathies were analyzed and among them 170 cases were compared with histopathology. The results are as follows. 1. Of ail the cases, 890 cases(73.2%) were diagnosed cytologically as benign, 312 cases(25.7%) as malignant, and 14 cases(1.1%) as unsatisfactory material. Reactive hyperplasia was diagnosed in 585 cases(65.7%) of the benign lesions, and among the malignant diseases, metastatic carcinoma was diagnosed in 248 cases(79.5%), and malignant lymphoma in 62 cases(19.9%). 2. The overall diagnostic accuracy was 89.2%, and no false positive case and 9 false negative results were observed among 170 cases which were proven by histopathology. Six cases of sampling error of false negative diagnoses included 3 of metastatic carcinomas and 3 of malignant lymphomas. The causes were difference between aspiration and biopsy site, poor fixation, or scanty cellularity with bloody smear. All 3 cases of misinterpretation error were malignant lympliomas, one of mixed type on biopsy which was diagnosed as reactive hyperplasia cytologically. In summary, FNAC technique is thought to be useful in the initial diagnosis of lymphadenopathies as well as in the follow-up of patients with known malignancy. Although the results of malignant lymphoma was less accurate than other malignant lesions, the application of strict cytologic criteria or lymphoid marker studies of aspiration material will reduce the false negative rate.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.34-38
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• 2015

Progressive transformation of germinal centers(PTGC) is a rare benign lymph node enlargement characterized by chronic lymphadenopathy and the presence of germinal centers with fused and expanded mantles within a lymph node that are 3-5 times the size of a typical reactive follicle. Although PTGC is reported in 3.5-10% of chronic lymphadenopathy, head and neck surgeons do not often experience this condition and its clinical implications. Althoug PTGC is benign disease, it could not be excluded the association with other malignant lymphoid diseases. Therefore, periodic follow up of PTGC patient could be required. We report two cases at this study ; a 16 years old man who visited out-patient clinic due to palpable mass of right cervical area, several months ago, and a 35 years old man who visited out-patient clinic for evaluating right cervical mass. Both of two patients were diagnosed with PTGC. In this study, we focus on the clinic-pathologic features of this uncommon disease along with other literature reviews.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.251-255
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• 2009

Kawasaki disease is an acute systemic inflammatory disorder, the etiology of which has not yet been established. The clinical manifestations are non-specific and are common to many pediatric infectious and immunologic diseases. In 2 cases presenting fever, cervical lymphadenopathy, and retropharyngeal abscess-like lesions on the neck shown in a computerized tomography (CT) scan, the diagnosis of Kawasaki disease was delayed. The patients were not responsive to antibiotic therapy, and fluid collection was not found during retropharyngeal aspiration. They showed typical Kawasaki manifestations over time and atrioventricular valve regurgitation in the echocardiogram. A diagnosis of Kawasaki disease should be considered in similar cases of fever and cervical lymphadenopathy. A CT scan that shows a retropharyngeal abscess-like lesion on the neck can be a false positive finding, and other laboratory exams, including echocardiography, should be performed as early as possible to avoid unnecessary medical and surgical procedures.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.439-444
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• 2002

We report a very rare case of mediastinal tuberculosis in a 57-year old woman who presented with a large mediastinal cyst on chest radiography. She had a 10-year history of exertional dyspnea, but felt comfortable at a rest. A subsequent chest CT suggested a mediastinal cyst with mediastinal lymphadenopathy and communicating pericardial sac. She underwent a thoracotomy and excision of the mass, which was histologically revealed to be of tuberculous origin. Although rare, the apparent increase in the incidence of tuberculosis may result mediastinal cysts being diagnosed mediastinal tuberculosis. We also briefly review mediastinal lymphadenopathy due to tuberculosis.

• Korean Journal of Head & Neck Oncology
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• v.19 no.2
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• pp.133-136
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• 2003

Background and Objectives: Kikuchi's disease or subacute necrotizing lymphadenitis is a cause of persistently enlarged lymph nodes unresponsive to antibiotic therapy. It affects predominantly young women under the age of 30, and it is seen primarily in the Asian population. Although this disease usually follows a benign course, all describing a clinical entity that has been mistaken for malignant lymphoma, lupus, and an assortment of infectious diseases. The purpose of this study is to report clinical characteristics and treatment outcome in order to contribute to the precise diagnosis and treatment. Materials and Methods: We reviewed 27 cases, who were diagnosed as subacute necrotizing lymphadenitis on excisional biopsy during the past 5 years from January 1998 to December 2002. Results: It occurred more often in females (20 cases ; 74%) than males (7cases ; 26%), and it was seen more frequently in the second and third decades (21 cases ; 78%). Cervical lymphadenopathy were usually multiple (24 cases, 89%) and measured less than 2cm (20 cases, 74%). The posterior cervical and deep jugular chains are the most common location(34 cases ; 81%). Leukopenia(18 cases, 67%) and elevated ESR(20 cases, 75%) were commonly noted in laboratory data. Conclusions: It is easy that Kikuchi's disease is mistaken for malignant lymphoma. So we should consider fine needle aspiration or open biosy of lymph node for histologic diagnosis in patients who have localized cervical lymphadenopathy unresponsive to antibiotic therapy.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.164-171
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• 2000

Background and Objectives： Necrotizing lymphadenitis or Kikuchi's disease is characterized by cervical lymphadenopathy of unknown etiology with unique histologic findings in young female patients. The importance of this disease lies in the fact that it can be easily misdiagnosed as malignant lymphoma, hence, clinicians need to aware of this disease entity. The purpose of this study is to report the clinicopathologic findings, radiographic findings, and many laboratory tests in order to contribute to the diagnosis and treatment of necrotizing lymphadenitis. Materials and Methods： We evaluated 31 patients, who were diagnosed as necrotizing lymphadenitis by excisional biopsy or fine needle aspiration cytology or ultrasound guided 18G cutting needle biopsy, retrospectively. Result : The median age was 24.8 years (range 12 to 43 years) and the male to female ratio was 1 : 2.4(9：22), with 14 females (45.1%) under 30 years. The common chief complaints were neck mass, easy fatigue and fever. Lymph node enlargement was limited to the cervical area in most cases (28cases : 90.3%). The involved lymph nodes were usually multiple (20cases : 64.5%), unilateral (26cases 83.9%) and small sized. Leukopenia (19cases : 61.3%) and elevation of ESR (18cases : 58.1%) appeared most frequently in the abnormal laboratory data. These symptoms will be gone spontaneoulsy without any specific treatment in several weeks or months. Conclusion : We should consider open biopsy or fine needle aspiration cytology or ultrasound guided cutting needle biopsy with lymph node in patients who have cervical lymphadenopathy with easy fatigue and fever, especially young women to exclude other conditions such as malignant lymphoma and tuberculosis, etc.