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Unexplained Fever In Hematologic Disorders Section 1. Benign Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
If lymphadenopathy persists for more than 4 to 6 weeks without an obvious cause, a lymph node biopsy must be done. According to various series,1 50 to 60% of the biopsies yield a positive diagnosis; 25% of cases with nondiagnostic biopsy, or “atypical lymphoid hyperplasia” (histologically suspicious but no clear-cut diagnosis of lymphoma) will develop a lymphoproliferative disorder within a year. Careful follow-up and repeated biopsies should be performed if the enlarged lymph nodes or the symptoms persist.
The Non-Hodgkin’s Lymphomas and Plasma Cell Dyscrasias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Lynne V. Abruzzo, L. Jeffrey Medeiros
Stage is the most important prognostic variable in patients with MF/SS, and reflects tumor burden and/or biologic behavior. Patients with disease confined to the skin (stage I) have a clinically indolent disease, with long survival (up to 30 years) and the best response to treatment. Survival is much shorter with the presence of lymphadenopathy, even if lymph node biopsy fails to demonstrate involvement (stage II). Patients with histologically proven lymph node involvement (stage III) or visceral disease (stage IV) have the worst survival. A Tumor Nodes Metastasis (TNM) staging system is also used. In addition, patients with the tumor form of disease and those over 50 years of age have poorer survival.
The spleen
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Conditions that result in splenomegaly can be diagnosed on the basis of the history and examination findings and from laboratory examination. In haemolytic anaemia, a full blood count, reticulocyte count and tests for haemolysis will determine the cause of the anaemia. Splenomegaly associated with portal hypertension caused by cirrhosis is diagnosed on the history, physical signs of liver dysfunction, abnormal tests of liver function, often anaemia, leukopenia and thrombocytopenia, as well as endoscopic evidence of oesophageal varices. Sinistral or segmental portal hypertension may result from isolated occlusion of the splenic vein by thrombosis, pancreatic inflammation or tumour infiltration. As many conditions that cause splenomegaly are associated with lymphadenopa- thy, investigation should be directed at those disease processes known to be associated with both physical signs. Lymph node biopsy may be required.
The impact of COVID-19 pandemics on dermatologic surgery: real-life data from the Italian Red-Zone
Published in Journal of Dermatological Treatment, 2022
Laura Cristina Gironi, Paolo Boggio, Roberto Giorgione, Elia Esposto, Vanessa Tarantino, Giovanni Damiani, Paola Savoia
According to the Crisis Unit declaration, we performed only surgical procedures of oncological relevance, life-saving surgical procedures, and diagnostic biopsies in lesion clinically ambiguous with a lethal disease in the differential diagnosis (i.e. pemphigus). We did not limit surgical procedures that routinely are performed in the SSU: (i) simple surgical excision (e.g. elliptical excision), (ii) complex skin surgery procedures (e.g. MOHS micrographic surgery and its variants), (iii) sentinel lymph node biopsy, or (iv) complex reconstruction techniques (grafts, flaps, etc.). Whenever possible (i.e. in case of small surgical excisions/biopsies), we used dissolvable stitches to avoid post-surgical control (19,20). We preferred primary instead of secondary intention healing, especially in the peri-ocular/oral/nasal areas, to avoid surgical wounds adjacent to the respiratory/ocular tract capable of increasing COVID-19 vulnerability (21). Facial sutures and dressings would compromise use of PPE were, if possible, avoided.
Kikuchi Fujimoto disease: sinister presentation, good prognosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Rahim A. Jiwani, Daniel N. Jourdan, Adrian Pona, Deepak Donthi, J. Stephen Stalls, Rita W. Rehana
(Image 1)Table 1). Peripheral blood smear showed normal appearing granulocyte and erythrocyte colonies with giant platelets present. The constellation of findings in the setting of B-symptoms were concerning and differential diagnosis included lymphoma, SLE, human immunodeficiency virus, and infection. Both autoimmune and infectious testing were negative (Table 2). Chest computed tomography scan was unremarkable; however, abdominal and pelvic computed tomography reported retroperitoneal and inguinal adenopathy. Since noninvasive diagnostic tests were nonspecific, an excisional lymph node biopsy was performed. Flow cytometry was negative for monotypic B-cells of aberrant CD4:8 ratio that may be indicative of lymphoma. Immunohistochemistry reported histiocytic necrotizing lymphadenitis and lymphoid cells located pericapsular with extensive areas of necrosis and apoptotic debris (Image 1 and 2). Since the necrotizing lymphadenitis had absent neutrophils, histopathology was consistent with KFD (Image 3). As the condition is extremely rare in the USA, tissue samples were sent to another institution for pathology review which confirmed the diagnosis. Due to the patient’s ongoing symptoms, he was started on a prednisone taper, 75 milligrams (mg) for 2 weeks; 50 mg for 1 week, 20 mg for 1 week and finally 5 mg for 1 week. At 3-week follow-up, his B symptoms, lymphadenopathy, and pancytopenia resolved; however, patient was referred to a rheumatologist due to increased risk of SLE.
The fine-needle aspiration cytology and clinical findings of Kikuchi–Fujimoto disease in pediatric patients: a retrospective clinical study
Published in Acta Oto-Laryngologica, 2022
Yuto Naoi, Tomoyasu Tachibana, Yoji Wani, Machiko Hotta, Katsuya Haruna, Yasutoshi Komatsubara, Kazunori Kuroda, Soichiro Fushimi, Tami Nagatani, Yuko Kataoka, Kazunori Nishizaki, Yasuharu Sato, Mizuo Ando
Histiocytic necrotizing lymphadenitis, also known as Kikuchi–Fujimoto disease (KFD), is a self-limiting inflammatory disease characterized by lymphadenopathy with tenderness and fever. The diagnosis of KFD usually depends on histopathological examination of samples obtained from enlarged lymph nodes [1]. In typical KFD, the lymph nodes show a necrotizing process, with patchy or confluent areas of necrosis associated with karyorrhexis and the absence or scarcity of neutrophils [2]. However, performing a lymph node biopsy under local anesthesia is often difficult in pediatric patients. Moreover, lymph node biopsy with a skin incision is not easily accepted as a diagnostic procedure, from an esthetic perspective.