Linfadenopatías generalizadas como manifestación inicial de lupus eritematoso sistémico: a propósito de un caso clínico

La presencia de linfadenopatías generalizadas se ha asociado de forma usual con lupus eritematoso sistémico (LES), sin embargo, no es usual encontrar este hallazgo como manifestación inicial de la enfermedad. Existen múltiples diagnósticos diferenciales que incluyen la linfadenitis necrotizante histiocítica de Kikuchi, la enfermedad de Castleman, infecciones y el linfoma cuando se presenta este hallazgo como síntoma inicial de LES. Presentamos el caso de un hombre de 56 años que se presentó con 2 meses de linfadenopatía generalizada sin datos al examen o antecedentes que sugirieran diagnóstico de LES; se sospechó inicialmente linfoma o enfermedad infecciosa y se realizó un estudio exhaustivo incluido biopsia de ganglio cervical. La investigación de laboratorio finalmente reveló leucopenia, proteinuria significativa, ANA y anti-dsDNA positivos e hipocomplementemia, lo que confirma el diagnóstico de enfermedad autoinmune tipo LES. Este caso ilustra la importancia de reconocer esta forma de presentación inusual, dado que se trata de una enfermedad potencialmente fatal.

The presence of generalized lymphadenopathy has usually been associated with systemic lupus erythematosus (SLE), however, it is not usual to find this finding as an initial manifestation of the disease. There are multiple differential diagnoses that include Kikuchi histiocytic necrotizing lymphadenitis, Castleman disease, infections and lymphoma when this finding is presented as an initial symptom of SLE. We present the case of a 56-year-old man who presented with 2 months of generalized lymphadenopathy without examination findings or history suggesting a diagnosis of SLE; Lymphoma or infectious disease was initially suspected and an exhaustive study was performed, including cervical lymph node biopsy. Laboratory investigation finally revealed leukopenia, significant proteinuria, positive ANA, positive anti-dsDNA, and hypocomplementemia, confirming the diagnosis of SLE-type autoimmune disease. This case illustrates the importance of recognizing this unusual presentation, given that it is a potentially fatal disease.

Adenopatía dermatopática simulando quiste branquial / Dermatopathic lymphadenopathy mimicking brachial cyst

Resumen La adenopatía dermatopática es una entidad histopatológica que consiste en un aumento del tamaño ganglionar en respuesta a enfermedades cutáneas crónicas. En el análisis histopatológico se observa una hiperplasia paracortical con presencia de células dendríticas, células de Langerhans e histiocitos. La presentación clínica más habitual es la aparición de adenopatías de características benignas con o sin prurito en pacientes con antecedentes de enfermedad cutánea. La aparición de masas laterocervicales es un motivo de consulta frecuente en otorrinolaringología. Presentamos el caso de un paciente exfumador de 41 años que consultó por aparición brusca de una masa cervical quística, sugestiva de quiste braquial o de una adenopatía quística. Una vez descartada malignidad, se procedió a realizar exéresis de la lesión mediante cervicotomía para diagnóstico patológico. El estudio de la muestra confirmó el diagnóstico de adenopatía dermatopática en un paciente sin antecedente de enfermedad cutánea previa.

Abstract Dermatopathic lymphadenopathy is a histopathologic entity which consists on reactive lymphadenopathy in the setting of chronic cutaneous diseases. The histologic examination is characterized by paracortical hyperplasia with presence of dendritic cells, Langerhans cells and histiocytes. The most common clinical presentation is the presence of lymphadenopathy with benign characteristics with or without pruritus in patients with prior history of cutaneous disease. The appearance of laterocervical masses is a frequent reason for consultation in otorhinolaryngology. We present the case of a 41-year-old ex-smoker who consulted due to the sudden appearance of a cystic cervical mass, suggestive of a brachial cyst or cystic adenopathy. Once malignancy had been ruled out, excision of the lesion within cervicotomy was performed in order to reach a pathological diagnosis. The histologic study confirmed the diagnosis of dermatopathic adenopathy in a patient with no history of previous skin disease.

Isolated Index Finger Dactylitis with Hilar Adenopathy

Dactylitis due to tuberculosis (TB) is an extremely uncommon manifestation of TB. We report a unique case of isolated index finger dactylitis with right hilar adenopathy due to TB in a 15-year-old immunocompetent student. High index of clinical suspicion, radiological findings and histological confirmation helped in the diagnosis. Anti-tuberculous therapy remains the cornerstone for the management of these cases.

Linfadenopatía reactiva por vacuna Pfizer-BioNTech para COVID-19: reporte de un caso / Reactive lymphadenopathy due to Pfizer-BioNTech COVID-19 vaccine: a case report

Uno de los efectos secundarios encontrados en pacientes con antecedente de vacunación por COVID-19, especialmente con la vacuna Pfizer-BioNTech, es la aparición de múltiples adenopatías hiperplásicas, principalmente en los ganglios linfáticos axilares, supraclaviculares e infraclaviculares ipsilaterales al sitio de vacunación. Presentamos el caso de una paciente femenina de 33 años, con aparición de masa dolorosa supraclavicular izquierda, quien una semana antes había sido vacunada con la primera dosis de la vacuna Pfizer-BioNTech en región deltoidea izquierda. Los hallazgos citológicos fueron sugestivos de una enfermedad linfoproliferativa, y el estudio histopatológico reveló linfadenopatía reactiva con proliferación de inmunoblastos B activados, secundaria a la vacunación contra COVID-19. Aportamos a la literatura con la caracterización de los hallazgos histopatológicos de la linfadenopatía posvacunación contra COVID-19. Es importante que los médicos tratantes y radiólogos estén familiarizados con este diagnóstico diferencial, para brindar recomendaciones adecuadas basadas en un seguimiento a corto plazo, en lugar de realizar biopsias, intervenciones y conductas inmediatas innecesarias en el manejo de los pacientes

One of the side effects found in patients with a history of vaccination for COVID-19, especially with the Pfizer-BioNTech vaccine, is the appearance of multiple hyperplastic adenopathies, mainly axillary, supraclavicular and infraclavicular lymph nodes ipsilateral to the vaccination site. We present the case of a 33-year-old female patient, with the appearance of a painful left supraclavicular mass, who was vaccinated a week earlier with the first dose of the Pfizer-BioNTech vaccine in the left deltoid region. The cytological findings were suggestive of a lymphoproliferative disease, and the histopathological study revealed reactive lymphadenopathy with proliferation of activated B immunoblasts, secondary to vaccination against COVID-19. We contribute to the literature with the characterization of the histopathological findings of COVID-19 post-vaccination lymphadenopathy. It is important for treating physicians and radiologists to be familiar with this differential diagnosis, in order to provide appropriate recommendations based on short-term follow-up, instead of performing unnecessary immediate biopsies or interventions in patient management.

Metástasis cervical de cáncer papilar oculto de tiroides: reporte de casos / Cervical metastasis from occult papillary thyroid cancer: case report

El microcarcinoma papilar de tiroides es definido como un tumor de un cm o menos de diámetro mayor. La mayoría permanecen ocultos clínicamente, siendo un hallazgo en autopsias hasta en 36%. La presentación oculta ocurre hasta en un 10 a 26% de todas las neoplasias malignas de tiroides y se define como la presencia de ganglios metastásicos de carcinoma papilar de tiroides en ausencia de lesión primitiva tiroidea evidente durante la exploración clínica y ecográfica. El objetivo de este trabajo es el reporte de dos casos donde el diagnóstico de cáncer de tiroides se realizó a través de su presentación metastásica cervical, siendo el estudio anatomopatológico de la pieza de resección quirúrgica el que devela la presencia de un microcarcinoma papilar. Si bien el tratamiento del de estas lesiones es controversial, existen elementos que sellan la necesidad de resolución quirúrgica. En el debut metastásico ganglionar cervical, está indicada la tiroidectomía total con el vaciamiento ganglionar cervical radical modificado ipsilateral y central. El raidioyodo postquirúrgico será empleado en forma complementaria ante la persistencia, recurrencia o elementos de alto riesgo.

Papillary thyroid microcarcinoma is defined as a tumor one cm or less in diameter. Most remain clinically hidden, being an autopsy finding in up to 36%. Occult presentation occurs in up to 10% to 26% of all thyroid malignancies and is defined as the presence of metastatic nodes from papillary thyroid carcinoma in the absence of a primitive thyroid lesion evident on clinical and ultrasound examination. The objective of this work is the report of two cases where the diagnosis of thyroid cancer was made through its cervical metastatic presentation, being the pathological study of the surgical resection specimen that reveals the presence of a papillary microcarcinoma. Although the treatment of these lesions is controversial, there are elements that seal the need for surgical resolution. In cervical lymph node metastatic debut, total thyroidectomy with modified ipsilateral and central radical cervical lymph node dissection is indicated. Post-surgical radiation iodine will be used in a complementary way in the event of persistence, recurrence or high-risk elements.

Tuberculosis en cabeza y cuello. Experiencia en la Patagonia chilena y revisión de la literatura / Tuberculosis in head and neck. Experience in Chilean Patagonia and literature review

La tuberculosis (TBC) es una de las patologías infecciosas que más muertes ha producido a nivel mundial, sobrepasando al virus de inmunodeficiencia humana (VIH). En Chile a pesar de la baja incidencia de la patología, aun no es posible llegar a su erradicación. La TBC es una enfermedad que habitualmente compromete el pulmón, sin embargo, en ocasiones compromete otros sitios del organismo, siendo la ubicación en cabeza y cuello una de las más importantes. Las manifestaciones clínicas son variadas y el curso de estas puede ser larvado, simulando otras patologías de mayor frecuencia en el ámbito otorrinolaringológico y transformando su diagnóstico en un desafío mayor. En este artículo se presentan tres casos clínicos diagnosticados y manejados en nuestra en región, además de una revisión de la literatura disponible en relación a la presentación clínica, orientación diagnóstica y tratamiento de la patología.

Tuberculosis is one of the infectious diseases which has produced more deaths around the world, even more than human immunodeficiency virus. In Chile, despite of the low incidence, there is still not possible to eradicate it. Tuberculosis is a disease which commonly compromises lungs, however, in some occasions involves another site of the organism, been the location in head and neck one of the most important. The clinical features are diverse and the natural history of those can be masked, for this reason it can simulate another more frequent disease in otolaryngology field, making the diagnosis a real challenge. In this article, we present three clinical cases diagnosed and treated in our region, besides, a review of the available literature related with the clinical presentation, diagnosis orientation and treatment of this pathology.

Síndrome hemofagocítico en pediatría, reporte de un caso / Hemophagocytic syndrome in pediatrics: a case report

RESUMEN Introducción: el síndrome hemofagocítico es una grave enfermedad que se caracteriza por la activación exagerada del sistema inmune y aumento de la actividad linfocítica citotóxica y macrofágica, que puede ser fatal. Presentación del caso: lactante de tres meses de edad, femenina, blanca, nacida producto de un embarazo normal, parto eutócico a las 39 semanas de gestación, con un peso al nacer de 3,6Kg, Apgar 9:9, sin complicaciones pre, peri, ni post natal. Es remitida al hospital por presentar vómitos, somnolencia, febrícula y pobre progreso de peso, al examen físico se constata visceromegalia, en los complementarios realizados se reciben las aminotransferasas en cifras muy elevadas, TGP: 1540 y TGO: 1590, así como la FA 800 UI/L, GGT 100UI/L y triglicéridos 2mmol/L, hemograma con una leucocitosis 19 x 109 /L con un 82 % de linfocitos, en el medulograma se comprueba la actividad macrofágica intramedular. Se inicia el tratamiento según protocolo del mismo, no muestra mejoría, evoluciona tórpidamente hacia la disfunción múltiple de órganos y fallece. Conclusiones: el síndrome hemofagocítico es infrecuente y requiere un alto índice de sospecha. El conocimiento de los criterios presentes en esta enfermedad permitiría el pensamiento diagnóstico y la terapéutica precoz y efectiva para los pacientes, con una mayor supervivencia.

ABSTRACT Introduction: hemophagocytic syndrome is a serious disease characterized by exaggerated activation of the immune system and increased cytotoxic and macrophagic-lymphocytic activity, which can be potentially fatal. Case report: 3-month-old female infant, white skin, born of a normal pregnancy, eutocic delivery at 39 weeks of gestation, with a birth weight of 3,6 kg, Apgar 9:9, without pre-, peri- or post-natal complications. She was referred to the hospital because of vomiting, somnolence, fever and poor weight gain, the physical examination showed visceromegaly, in the complementary tests the aminotransferases were very high, TGP: 1540 and TGO: 1590, as well as FA 800 UI/L, GGT 100UI/L and triglycerides 2mmol/L, hemogram with leukocytosis 19 x 109 /L with 82 % of lymphocytes, in the medullogram an intramedullary macrophage activity is verified. Treatment was initiated according to protocol, but she did not show improvement, evolving torpidly to a multiple organ failure and died. Conclusions: hemophagocytic syndrome is infrequent and requires a high index of suspicion. Knowledge of the criteria present in this condition would allow the diagnostic thinking, as well as the early and effective therapeutic for patients, with better survival rate.

Síndrome PFAPA: reporte de un caso clínico / PFAPA syndrome: a case report

El síndrome PFAPA es la entidad más frecuente dentro de los síndromes de fiebres periódicas que pueden manifestarse desde la infancia. Es un síndrome autoinflamatorio caracterizado por una disfunción en las citoquinas, de carácter autolimitado y de etiología desconocida, aunque se han reportado casos de presentación familiar; lo que sugiere la existencia de una base genética de la enfermedad. Se presenta con episodios febriles que suelen acompañarse de aftas orales, adenopatías cervicales, faringoamigdalitis y síntomas constitucionales. En los exámenes de laboratorio es frecuente encontrar elevación marcada de la proteína C reactiva, leucocitosis y aumento de IgG, IgA e IgM. El diagnóstico se realiza utilizando los criterios modificados de Thomas, que incluyen parámetros clínicos, antecedentes y diagnósticos de exclusión. Se presenta el caso de un paciente de 4 años de edad que consultó a un hospital por un cuadro febril, movimientos tónico-clónicos generalizados, desviación de la mirada, sialorrea y relajación de esfínteres. También presentó cefalea de localización frontal y odinofagia. En la cavidad oral se observaron lesiones tipo aftas, y se evidenciaron adenopatías cervicales. El paciente no respondió al manejo con antibióticos, y se observó que cumplía con los criterios de diagnóstico para síndrome PFAPA, luego de descartarse un proceso infeccioso. Se inició terapia con corticoides con respuesta favorable y se concluyó que el paciente tenía un cuadro compatible con síndrome PFAPA.

PFAPA syndrome is the most frequent illness within the syndromes of periodic fevers manifesting during childhood. It is an auto-inflammatory syndrome characterized by cytokine dysfunction, a self-limiting nature, and unknown etiology; family cases have been reported, suggesting the existence of a genetic basis for the disease. PFAPA syndrome is manifested with febrile episodes that are usually accompanied by oral aphthae, cervical adenopathy, pharyngotonsillitis and constitutional symptoms. In laboratory tests, it is common to find marked elevation of C reactive protein, leukocytosis and increased IgG, IgA and IgM levels. Diagnosis is reached by means of the modified Thomas criteria that include clinical parameters, personal and family history, and exclusion diagnoses. The case of a 4-year-old patient who visited the hospital with fever, generalized tonic-clonic seizures and sphincter relaxation is presented. The patient reported frontal headache and odynophagia. Aphthous stomatitis was observed, and cervical adenopathies were evident. The patient did not respond to antibiotic therapy, and met the diagnostic criteria for PFAPA syndrome after an infectious process was ruled out. Corticosteroid therapy was initiated with a favorable response. It was concluded that the patient had a diagnosis compatible with PFAPA syndrome

Real time endobronchial ultrasound guided transbronchial needle aspiration of intrathoracic lymphadenopathy: an initial experience

Background: Conventional TBNA has been used in the evaluation of intrathoracic lymphadenopathy with varied success rates depending upon size, site and aetiology of the node. Although mediastinoscopy has higher successes but it comes at the cost of general anaesthesia, more complications and limited access to the inferior and posterior mediastinum. Endobronchial ultrasound guided transbronchial needle aspiration has the advantage of real time nodal sampling with good success rates and minimal complications. The aim of our study was to assess the diagnostic yield and safety of EBUS TBNA in the evaluation of intrathoracic lymphadenopathy.Methods: This prospective observational study was conducted at government chest diseases hospital Srinagar over a period of two years from January 2016-December 2018 on 100 consecutive patients who underwent EBUS TBNA procedure for evaluation mediastinal and hilar lymphadenopathy. The data was collected and analysed for diagnostic yield and safety profile.Results: Out of the 100 subjects included in the study 52% were males and 48% were females. Mean age of the study population was 48.5±16.65 years. Most of the nodes sampled were subcarinal in location followed by paratracheal and hilar group. Granulomatous pathology (tuberculosis and sarcoidosis) was present in 41 patients followed by malignancy in 39 patients. Anthracosis was the cause of lymphadenopathy in 4 of the patients. There were no major complications in our study.Conclusions: EBUS TBNA is an effective and safe procedure for evaluation of mediastinal and hilar lymphadenopathy.

Diagnóstico postmortem de un caso con síndrome hemofagocítico secundario / Postmortem diagnosis of a case with secondary hemophagocytic syndrome

Introducción: El síndrome hemofagocítico, llamado también linfohistiocitosis hemofagocítica o síndrome de activación macrofágica, es una grave enfermedad que se caracteriza por la activación exagerada del sistema inmune y aumento de la actividad linfocítica citotóxica y macrofágica, que puede ser potencialmente fatal. Objetivo: Describir un caso con este síndrome poco frecuente pero de alta mortalidad. Presentación del caso: Paciente de 10 meses, nacido de parto eutócico, a término, normopeso, con antecedentes de ingreso a los dos meses por sepsis, con aumento de las transaminasas y adenopatías cervicales. Se realizó biopsia del ganglio cervical y se diagnosticó adenitis granulomatosa. En esta ocasión, cuatro días antes del ingreso comenzó con fiebre y decaimiento; al examen físico presentó tiraje intercostal bajo, polipnea superficial, hepatomegalia y esplenomegalia. Exámenes complementarios, presentó anemia, transaminasas, albúmina y proteínas totales elevadas; orina con pigmentos biliares y cuerpos cetónicos positivos; plaquetas 100 x 109. Los especialistas de gastroenterología plantearon una colestasis del lactante. El paciente falleció y en la necropsia se constató una hepatoesplenomegalia, hígado amarillento, adenopatías mesentéricas y peripancreáticas, pulmones hemorrágicos con aumento de consistencia; en el estudio microscópico se encontró en hígado, bazo, médula ósea, y ganglios linfáticos, histiocitos con hemofagocítosis. Conclusiones: El síndrome hemofagocítico es una enfermedad poco frecuente que muchas veces no se sospecha y pasa inadvertido, por lo tanto hay que pensar en dicha entidad porque tiene implicaciones pronósticas graves para el paciente, como puede ser un desenlace fatal(AU)

Introduction: The hemophagocytic syndrome, also called hemophagocyticlymphohistiocytosis or macrophage activation´s syndrome is a serious disease characterized by exaggerated activation of the immune system and increased cytotoxic lymphocytic and macrophage activity, which can be potentially fatal. Objective: To describe a case with this rare syndrome with a high mortality rate, and the diagnosis was made postmortem in our hospital. Case presentation: A 10-month-old patient, born by natural delivery, with normal weight, with a history of admission at 2 months due to sepsis, with increased transaminases levels and cervical adenopathies. A cervical lymph node biopsy was performed, and granulomatous adenitis was diagnosed. On this occasion, four days before admission, he presented fever and weakness; physical examination revealed low intercostals retraction, superficial polypnea, hepatomegaly and splenomegaly. The complementary tests showed anemia, transaminases, albumin and total proteins with high levels; urine had bile pigments and positive ketone bodies; platelets 100 x 109. Gastroenterology specialists set out cholestasis of the infant. The patient died and at necropsy there were evidences of hepato splenomegaly, yellowish liver, mesenteric and peripancreatic adenopathies, hemorrhagic lungs with increased consistency. In the microscopic study, histiocytes with hemophagocytosis were found in liver, spleen, bone marrow, and lymph nodes. Conclusions: The hemophagocytic syndrome is a rare disease that often goes unnoticed. It has serious prognostic implications for the patient with a fatal outcome(AU)

Sclerosing polycystic adenosis of the parotid gland: a case report and literature review / 口腔疾病防治

Objective @#To explore the clinicopathological features, diagnosis, treatment and prognosis of sclerosing polycystic adenosis (SPA) and provide a reference for clinics.@*Methods @#A case of sclerosing polycystic adenosis of the parotid glands was retrospectively analyzed, and the relevant literature was reviewed.@*Results @# A 57-year-old female patient presented with a tumor, which she had noticed for half a month, on the left side of the lower ear, with occasional paroxysmal numbness and no complaint of other discomfort. Resection of the left submandibular area tumor was performed, and the tumor specimen pathological results showed sclerosing polycystic adenosis of the left parotid gland, with no recurrence after six-months follow-up. Sclerosing polycystic adenosis is rare, occurs in the parotid gland and is characterized by a frequently painless, slow-growing mass of the parotid gland. Imaging examination and fine needle aspiration biopsy can only be used as a reference; the diagnosis must include a pathology examination. Histological manifestations showed that abundant sclerotic collagenous stroma was permeated by ductal and acinar lobules, and cystic dilatation of the duct was accompanied by epithelial hyperplasia and diverse ductal cells. Immunohistochemistry of the ductal and acinar cells showed positive expression of cytokeratin (AE1-3 and CAM5.2) and S100 protein. The ducts filled with hyperplastic and dysplastic epithelium were surrounded by an intact myoepithelial layer that was positive for SMA, p63, and calponin, with a Ki-67 index less than 3%. Treatment comprised mainly surgical resection, with a good prognosis. However, one-third of cases relapse: low-grade malignant tumors may occur, with at least one report of invasive cancer.@*Conclusion@#Sclerosing polycystic adenosis of the salivary gland is rare and has a good prognosis, but patients may relapse easily after surgery. The diagnosis depends primarily on pathological examination. The main treatment is surgical resection, the prognosis is good, and follow-up should be strengthened after surgery.

Linfoadenitis histiocítica necrosante en una mujer joven / Necrosing histiocytic lymphadenitis in a young woman

Se describe el caso clínico de una paciente de 32 años de dad, que acudió a consulta por presentar cuadro febril y adénico desde hacía varias semanas, asociado a manifestaciones generales de anorexia y pérdida de peso. En el examen clínico se constató la presencia de adenopatías cervicales de 2 cm y orofaringe enrojecida. Los resultados de los exámenes complementarios efectuados y la evaluación histológica del ganglio linfático confirmaron que se trataba de una linfoadenitis histiocítica necrosante en fase proliferativa (enfermedad de Kikuchi Fujimoto). El estudio inmunohistoquímico no reveló malignidad.

The case report of a 32 year-old patient is described who attended the department for presenting adenoid and febrile condition for several weeks, associated with general manifestations of anorexy and weight loss. In the clinical examination the presence of 2 cm cervical adenopathies and reddened oropharynx was confirmed. The results of the complementary tests and the histological evaluation of the lymph node confirmed that it was a necrosing histiocytic lymphadenitis in proliferative stage, (Kikuchi Fujimoto disease). The immunological histological and chemical study did not reveal malignancy.

Anemia hemolítica autoinmune como manifestación inicial de linfoma Hodgkin / Auto inmune hemolytic anemia how initial manifestation of Hodgkin lymphoma

Se presenta el caso de una paciente de 66 años de edad, a la que se le diagnóstica anemia hemolítica, la cual fue refractaria al tratamiento y requirió esplenectomía. Además presenta adenomegalias inguinales, cuya biopsia determina infiltración parcial por células linfoides B CD20+, con atipia, y CD30+, con factor de proliferación alto; en médula ósea se constata incremento de linfocitos T. Cuatro meses después, consulta por la aparición de adenopatías inguinales y axilares, de las cuales la biopsia reveló enfermedad de Hodgkin variante esclerosis nodular, y en médula ósea se evidenció infiltración por la enfermedad linfoproliferativa. Si bien es infrecuente la asociación entre anemia hemolítica y linfoma Hodgkin, debe tenerse en cuenta para llegar a la búsqueda oportuna de su causa y al diagnóstico de un probable proceso linfoproliferativo subyacente.

In this work we report and study a case of 66 year old woman, whit diagnosis of hemolytic anemia, which was refractory to treatment and she required splenectomy. The patient presented inguinal lymphadenopathy which biopsy has determined a partial infiltration of B-cells CD20+ and CD30+ with atypia and high growth factor. The bone marrow biopsy informed an increased number of T lymphocytes. Four month later, the patient complained due to the appearance of inguinal and axillaries lymph nodes, which biopsy revealed a nodular sclerosis Hodgkin lymphoma. The bone marrow biopsy showed infiltration by lymphoproliferative disease. Although the association between hemolytic anemia and Hodgkin lymphoma is less frequent, this fact should be taken into account in searching its cause and reaching the diagnosis of a probable underlying lymphoproliferative process.

Endobronchial Ultrasound-guided Transbronchial Needle Biopsy for Diagnosis of Mediastinal Lymphadenopathy in Patients with Extrathoracic Malignancy

Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.