Clinical analysis of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation / 中国感染与化疗杂志

Objective To explore the clinical features and surgical treatment of cervical tuberculous lymphadenopathy associated with abscess formation.Methods The clinical data of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation were reviewed and analyzed retrospectively.All the patients were treated in Shenzhen Third People's Hospital during the period from February 2012 to May 2014.Results The mean age of the 95 patients was (27.8±8.2) years.The average duration of the disease was 4.0 months.The tuberculous lymphadenopathy was most frequently found in Level Ⅳ cervical lymph nodes.Thirty-four patients were complicated with pulmonary tuberculosis.History of surgical treatment for tuberculous cervical lymphadenopathy was reported in 26 cases.Sixty-five patients were managed with incision and drainage plus dress changing.Twenty-two patients underwent abscess rinsing,excision and primary wound closure.And 8 patients received excision of ulcers and sinuses,and lymphadenopathy cleaning.The average healing time was (2.11± 1.76) months for incision and drainage.Abscess and ulcer reoccurred in 18 of the 65 patients after healing completely by incision and drainage.All the patients treated by the other two surgical modalities were cured as primary healing except 2 patients,who received local flap grafting after primary surgery.Conclusions Cervical tuberculous lymphadenopathy associated with abscess formation has special features in diagnosis and treatment.Surgical approach is usually effective if optimized for individual patients.

Tuberculous Cervical Lymphadenitis, Treatment and Outcome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is a clinically common cervical inflammatory disease. But there are controversies in the management in spite of high prevalence. The aim of this study was to investigate proper treatment modality, such as antituberculous chemotherapy and surgery. SUBJECTS AND METHOD: The study was based on a retrospective chart review in 65 patients with tuberculous cervical lymphadenitis who were treated between January 2001 and May 2005 at Gachon University Gil Medical Center, Incheon, Korea. We have studied clinical manifestations, characteristics of the neck masses, diagnostic approach, radiologic finding, treatment modality, treatment response, and prognosis. RESULTS: Females were more affected, by about three fold, than males and the prevalence rate was higher in younger patients ranging from 20 to 30. The diagnosis was made over 89% with the initial tests such as FNAB, AFB stain and tuberculous PCR. The successful treatment rate just with anti-tuberculous medication was 90.6%. Especially, in the patients with abscess formation, treatment was successful in 90% only with anti-tuberculous medication. Seventeen cases were treated with medication and surgical management. These patients underwent selective neck dissection or mass excision to remove the entire lesion and there were no recurrence. CONCLUSION: Tuberculous lymphadenitis can be managed well just with anti-tuberculous medication. But, if local symptoms get worse even though the patient is under medical treatment, early surgical treatment is needed. The important thing is to remove the entire lesion when the surgical treatment must be taken.

Diagnosis of Cervical Tuberculous Lymphadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the incidence of tuberculosis has decreased recently, cervical tuberculous lymphadenitis is one of the most common causes of neck mass in Korea. Its confirmative diagnosis is not common, especially when the presence of acid-bacilli is not proven. So, the treatment of cervical tuberculous lymphadenitis is generally carried out by clinical diagnosis, not by confirmative diagnosis. In this study, we designed to verify theusefulness of fine needle aspiration cytology (FNAC), AFB stain, Mycobacterium tuberculosis polymerase chain reaction (PCR) and excisional biopsy prospectively. MATERIALS AND METHODS: We underwent FNAC, AFB stain and PCR as a first stage work-up through fine needle aspiration in forty-eight patients who were suspected of cervical tuberculous lymphadenits. In patients with positive results on the first stage work-up, we treated the patients with antituberculosis chemotherapy under clinical diagnosis of tuberculosis. In patients with negative test results, we performed excisional biopsy. Also in patients who revealed positive results with no response to the antituberculosis chemotherapy, we performed an excisional biopsy too. RESULTS: The sensitivity and specificity of first stage work-up were 64.9% and 81.8%, respectively. The sensitivity of FNAC, AFB stain and PCR were 8.1%, 13.5% and 56.8 %, respectively. The specificity of PCR was 81.8%. Thirteen (59.1%) of 22 patients who revealed negative results in their first stage work-up were proven to have cervical tuberculous lymphadentis through excisional biopsy, and two of the positive results in PCR were false positive. CONCLUSION: In clinical diagnosis of cervical tuberculous lymphadentis, the first stage work-up used in this study is found to be useful methods which resulted 64.9% sensitivity and 81.8% specificity. Especially, PCR is the most useful tool among them and suggest that, if its result is negative, excisional biopsy should be considered positively.

Cervical tuberculous lymphadenitis : Clinicopathological reatures and AFB positivity / 결핵

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.

Clinical Investigation of Cervical Tuberculous Lymphadenitis / 결핵

BACKGROUND: Cervical tuberculous lymphadenitis(CTL) is one of the most common extra-pulmonary tuberculosis. Recently overall incidence of pulmonary tuberculosis has decreased, but the incidence of tuberculous lymphadenitis has not decreased. Its duration of treatment is still controversial and the pathogenesis, prognosis and relationship with other site tuberculous are poorly published. So we did a retrograde study of 120 cases of confirmed CTL about its clinical manifestations. METHODS: All patients were applied fine needle aspiration(FNA) of palpable enlarged cervical lymph nodes and 114 patients were examined for AFB smear and 34 patients for TB culture with aspirated fluid. 57 patients were examined Mantoux test(5TU with PPD-S). With above methods, a total of 120 patients was diagnosed as having CTL RESULTS: 1) CTL is most prevalent in young women between the age of 20 30 years and the incidence of CTL in female is 2.5 times higher than that of male. It is located most commonly in the posterior cervical area. The most common presenting symptom is painless palpable enlarged cervical lymph nodes. 2) With FNA of enlarged cervical lymph nodes, the percentage of histopathological positivity is 82.3%. The percentage of AFB smear positivity is 38.6%, and that of TB culture positivity is 17.6% (p<0.001). 3) Pulmonary tuberculosis is noted in 79 cases(65.8%). And 42 cases(53.5%) of them had minimal pulmonary tuberculosis. In 14 cases(11.7%),other extrapulmonary tuberculosis coexsisted and pleural tuberculosis was most common in the order. 4) CTL was treated with anti-tuberculous medication(first line drug) and median treatment duration was 18.5months. During treatment, the size of involved lymph nodes decreased gradually in 62 cases(75.8%), newly developed lymph nodes were found in 25 cases(30.4%),fluctuation formation in 22 cases(26.8%) and fistula formation in 14 cases(17.0%). CONCLUISON: CTL is prevalent in women between the age of 20 ~ 40 years and it involves posterior cervical area most commonly. CTL is treated with long-term anti-tuberculous chemotherapy. We think it is one manifestation of systemic disease and frequently coexisting with pulmonary tuberculosis. Despite anti-tuberculous chemotherapy, the size of involved lymph nodes was increased, new lymph nodes were developed or fluctuation and fistula formed in involved lymph nodes. After sufficient medication, when the patient felt pressure discomfort from enlarged lymph node or fistula was formed, we recommended total excision of involved lymph nodes.

A case of single cervical tuberculous cold abscess associated with multi-loculated tuberculous pleurisy / 결핵

St. Francisco General Hospital, Seoul, Korea. Although the incidence of pulmonary tuberculosis is declining, the number of extrapulmonary tuberculosis has remained constant. Tuberculous Lymphadenitis accounts for over 50% of total inflammatory lymphadenitis and the most common site is cervical lymph node. We report a case of single cervical tuberculous cold abscess associated with multiloculated and septated tuberculous pleurisy. Intracavitary urokinase instillation via percutaneous catheter is indicated in loculated and septated pleural effusion. And our result was satisfactory without complication.

A Case of Curretage and Anterior Fusion of Cervical Tuberculous Spondylitis Via Trotter Approach

A ase of 47 years old female with cervical tuberculous spondylits involving C2,3 and C4 is reported. The lesion was treated surgically by curretage and anterior fusion with iliac bone autograft via median labiomandibular glossotomy.