Comparison of clinical and pathological features of lymph node tuberculosis and histiocytic necrotizing lymphadenitis

Abstract

Introduction: The aim of this study was to investigate the basis for a differential diagnosis of lymph node tuberculosis and histiocytic necrotizing lymphadenitis.
 Methodology: This study selected 85 cases of lymph node tuberculosis (Group A patients) and 26 cases of histiocytic necrotizing lymphadenitis (Group B patients). The clinical and pathology features on both groups were analysed.
 Results: The Group A patients were older than the Group B patients (t = 5.233, P < 0.01); The Group B patients had less tuberculosis exposure history (x2 = 4.279, P < 0.01), and a higher frequency of tenderness (χ2 = 8.109, P < 0.01) and fever (x2 = 31.923, P < 0.01). The Group A patient group had a higher WBC level (t = 2.980, P < 0.01) and lower serum ALB (t = 5.508, P < 0.01); As seen through ultrasound imaging, Group B patients had more clear boundaries (70.59%), higher low-echo rates (82.36%) and low calcification rates (0%), Group A patients for whom these rates was 25.76%, 40.91% and 25.76% respectively. In terms of pathology data, the main manifestations of Group A patients were granulomatous inflammation with caseous necrosis, multinuclear giant cell reaction, and in some cases, acid-fast bacilli smears (+). In Group B patients, there were instances of coagulative necrosis surrounded by foam-like tissue cells without neutrophil infiltration.
 Conclusion: We found that the epidemiological history, clinical symptoms, laboratory examinations, ultrasound imaging and changes in pathology are very important for the identification of lymph node tuberculosis and histiocytic necrotizing lymphadenitis.

Sampling strategy for bacteriological diagnosis of intrathoracic tuberculosis

“…Nonetheless, contrary to BAL, TBNA procedure should be limited to patients with mediastinal or hilar lymphadenopathy visible in thoracic CT scan and accessible to endo-bronchial ultrasoundguided (EBUS) TBNA. In this last situation TBNA provides valuable support in the diagnosis of pulmonary TB [23][24][25][26][27][28][29], particularly in necrotic lymph nodes [29,38] and when ultrasound findings reveal clear boundaries and calcifications [28]. Above all, post-bronchoscopy sputum should be systematically collected after bronchoscopy each time BAL is performed, in view of its utility highlighted in our study and in others [39,40], to benefit to the full extent of the bronchoscopy.…”

“…Among per-bronchoscopy sampling procedures, endobronchial ultrasound transbronchial needle aspiration (TBNA) has recently demonstrated interesting safety and sensitivity in M. tb isolation in hilar and mediastinal lymphadenopathy [23][24][25][26][27][28][29]. A reasoned use of invasive procedures requires knowing the individual profitability of their relative sample in the microbiological diagnosis of TB, compared to non-invasive, inexpensive, and rapid sampling such as sputum with or without induction.…”

Histiocytic Necrotizing Lymphadenitis Mimicking Acute Appendicitis in a Child: A Case Report

“…The laboratory findings could be leukopenia and/or neutropenia, sometimes accompanied by increased levels of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) in serum (1)(2)(3)(4)(5). As a disease with low incidence, KFD is easily misdiagnosed as other diseases, such as lymphoma, lymph node tuberculosis, infectious mononucleosis, and Kawasaki disease (6)(7)(8)(9). However, initial symptom presenting as acute abdomen was rarely reported.…”