Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Vocal fold paralysis secondary to sarcoidosis is extremely rare but it can develop as a result of compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We report the case of a 56-year-old woman who presented with unilateral vocal fold paralysis and enlarged supraclavicular lymph nodes. Computed tomography of the neck revealed multiple, enlarged, and matted lymph nodes at the cervical level of IV. An ultrasound-guided core needle biopsy of the lymph node was performed, and a histopathological diagnosis of sarcoidosis was made by validating the presence of noncaseating granuloma. After implementation of steroid therapy, the patient exhibited immediate recovery from vocal fold paralysis. Although an extremely rare disease, sarcoidosis should be included in the differential diagnosis of vocal fold paralysis. Accurate diagnosis and prompt steroid treatment may reduce the morbidity of patients with vocal fold paralysis secondary to sarcoidosis.
Biopsy, Large-Core Needle ; Diagnosis ; Diagnosis, Differential ; Female ; Granuloma ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neck ; Paralysis ; Rare Diseases ; Sarcoidosis ; Vocal Cords

PURPOSE: This study evaluated the feasibility of acoustic radiation force impulse (ARFI) elastography and characterized the sonographic features of lymph nodes (LNs) with Kikuchi disease in pediatric patients. METHODS: Seventy-six cervical LN biopsies were performed for the diagnosis of cervical lymphadenopathy. ARFI imaging was performed, and the characteristic ultrasound features of the biopsied LNs and the contralateral LNs were analyzed. We also reviewed clinical and conventional ultrasonographic findings. RESULTS: On histology, 56 patients were diagnosed with Kikuchi disease. These LNs were large and elongated, with increased perinodal echogenicity and capsular thickening. In 38 of them, ARFI elastography was performed, and the median shear wave velocity (SWV) of the biopsied LNs with Kikuchi disease (2.19 m/sec; range, 1.45 to 4.57 m/sec) was higher than of the contralateral LNs (1.72 m/sec; range, 0.95 to 2.65 m/sec; P < 0.001). In patients with reactive hyperplasia, the mean SWV of the biopsied LNs (2.00 m/sec; range, 1.49 to 2.26 m/sec) was higher than that of the contralateral LNs (1.55 m/sec; range, 1.21 to 2.32 m/sec; P=0.031). CONCLUSION: The SWV of LNs with Kikuchi disease was significantly higher than that of the contralateral LNs. Morphologically, LNs with Kikuchi disease showed an enlarged, elongated, and oval shape, increased perinodal echogenicity, and capsular thickening. In addition to the conventional ultrasonographic findings, the application of ARFI is feasible even in pediatric patients for the evaluation of cervical lymphadenopathy.
Acoustics* ; Biopsy ; Diagnosis ; Elasticity Imaging Techniques* ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Hyperplasia ; Lymph Nodes ; Lymphatic Diseases ; Pediatrics ; Ultrasonography

Pharyngitis is a prevalent disease of the upper respiratory tract that requires treatment with an antibiotic. Group A streptococci (GAS) are the most frequent etiologic agents of bacterial pharyngitis. Because GAS are susceptible to penicillin, routine antibiotic susceptibility testing is not needed. Generally, patients with bacterial pharyngitis have high fever, cervical lymphadenopathy and tenderness, and tonsillar exudative discharge without symptoms of the common cold (e.g., cough, rhinorrhea, and sneezing). However, differentiating bacterial pharyngitis from viral pharyngitis based only on their clinical manifestations is problematic. Therefore, a bacterial culture or a rapid antigen detection test (RADT) is required for the diagnosis of bacterial pharyngitis. Although bacterial culture is the gold standard for diagnosis of bacterial pharyngitis, its accuracy is affected by the technical expertise of the technician, and there is a delay of 1–2 days before the results become available. In contrast, the sensitivity of RADT has increased to over 90%, making them suitable for screening purposes. The result of a RADT is available within 5–10 minutes, obviating the need for a second visit to obtain the results of culture. Use of a RADT would enable the optimal antibiotic to be administered earlier, reducing the overuse of antibiotics.
Anti-Bacterial Agents ; Common Cold ; Cough ; Diagnosis ; Drug Resistance ; Fever ; Humans ; Immunologic Tests ; Lymphatic Diseases ; Mass Screening ; Penicillins ; Pharyngitis ; Professional Competence ; Respiratory System

Malakoplakia is usually found in the genitourinary tract; however, it occurs uncommonly as a chronic inflammatory disease and rarely in the head and neck area, having been reported in the literature only few times. Here, we report, with a review of the related literature, a case of malakoplakia on the posterior neck. A 76-year-old male patient visited our institution presenting a rapidly growing neck mass that had invaded the overlying skin for several weeks. The results of imaging studies strongly indicated a malignant tumor, but an accurate diagnosis was not made until after a fine needle aspiration biopsy was undertaken twice. The lesion was completely excised with an extended radical neck dissection including the overlying skin and scalene muscle upon consent of the patient. The pathological diagnosis was made with various immunohistochemical staining methods including Von Kossa, Periodic acid-Schiff-diastase, CD-68 and CD163. During the 24 months follow-up after the surgery, there was no sign of recurrence.
Aged ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Lymphatic Diseases ; Malacoplakia ; Male ; Neck Dissection ; Neck ; Recurrence ; Skin

Splenic B-cell lymphomas (SBCLs) show characteristically pronounced splenomegaly without significant lymphadenopathy. Distinguishing hairy cell leukemia (HCL) from other SBCLs (splenic marginal zone lymphoma [SMZL], variant HCL [v-HCL], and splenic diffuse red pulp small B-cell lymphoma [SDRPL]) is essential to determine suitable treatments and prognoses. With advances in diagnostic modalities and therapies, splenectomy is not commonly performed, and thus diagnosis of HCL must be based on the results obtained using blood and bone marrow samples. Annexin A1 is known as the most specific marker for HCL. There has yet been no report of the assessment of annexin A1 immunostaining from Korea. In this study we analyzed samples from 13 Korean patients with SBCLs (three HCL, three v-HCL, six SMZL, and one SDRPL) from May 2001 to December 2016. Immunohistochemical analyses for annexin A1 and CD20 were performed using bone marrow sections; molecular analyses for detection of the BRAF V600E mutation were also performed. All HCL patients showed positive results for annexin A1 immunostaining and the presence of the BRAF V600E mutation, and negative results for other SBCLs. Our results confirmed the high specificity of annexin A1 and the BRAF V600E mutation as HCL markers. Molecular analysis requires expensive equipment and substantial manpower. Annexin A1 is a better alternative as an HCL marker than the BRAF V600E mutation in terms of cost-effectiveness.
Annexin A1 ; Bone Marrow ; Diagnosis ; Humans ; Korea ; Leukemia, Hairy Cell ; Lymphatic Diseases ; Lymphoma ; Lymphoma, B-Cell ; Prognosis ; Sensitivity and Specificity ; Splenectomy ; Splenomegaly

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.
Abscess ; Adolescent ; Anesthesia, Local ; Biopsy ; Diagnosis, Differential ; Diplopia ; Drainage ; Exophthalmos ; Eyelids ; Female ; Granuloma ; Humans ; Lacrimal Apparatus ; Lymphatic Diseases ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Orbital Diseases ; Periosteum ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Visual Acuity

BACKGROUND/AIMS: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. METHODS: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. RESULTS: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). CONCLUSIONS: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.
Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Multivariate Analysis ; Needles ; Prospective Studies ; Punctures ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
Aneurysm ; Arteries ; Bacterial Infections ; Child, Preschool ; Coronary Vessels ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Erythema Nodosum ; Erythema ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Lower Extremity ; Lymphatic Diseases ; Masks ; Mass Screening ; Mucocutaneous Lymph Node Syndrome ; Neck ; Oropharynx ; Salmonella ; Skin ; Subcutaneous Tissue

PURPOSE: To determine the prevalence and clinical findings of benign thyroid nodules and cancer in Korean pediatric patients with thyroid nodules. METHODS: We investigated the medical records of 134 patients aged younger than 18 years who had a goiter, thyroid nodule, thyroid mass, or thyroid cancer who underwent fine needle aspiration biopsy (FNAB). RESULTS: The study population included 113 females (84.3%) and 21 males (13.7%); the mean patient age was 16.1±2.3 years (range, 8–18 years). Of the 134 patients, 24 (18.0%) were finally diagnosed with thyroid cancer, of which 20 (83.3%) were papillary cancer and 4 (16.7%) were follicular cancer. No patient was exposed to radiation. FNAB revealed malignant cancer in 21 of the patients; 3 were initially reported as having benign tumors by FNAB, but were later diagnosed with follicular cancer. An additional 13 patients were suspected to have malignant tumors by FNAB, with a final diagnosis of nodular hyperplasia. Cystic nodules were more common in the benign group. The percentages of cervical lymphadenopathy and irregular nodular margins were higher in the malignant group compared to the benign group. Cervical lymphadenopathy and FNAB malignant findings were highly suggestive of malignant nodules. CONCLUSIONS: Thyroid cancer prevalence in a Korean pediatric population is comparable to reported estimates of worldwide thyroid cancer prevalence. In this population, cancer predominates on the right thyroid lobe. Papillary thyroid cancers are dominant in the Korean pediatric population but are less prevalent than in Korean adults. As expected, FNAB was highly accurate in predicting malignant nodules.
Adult ; Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Female ; Goiter ; Humans ; Hyperplasia ; Lymphatic Diseases ; Male ; Medical Records ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule*

OBJECTIVES: Adenovirus infection, which has been known to mimic Kawasaki disease (KD), is one of the most frequent conditions observed during differential diagnosis when considering KD. Accordingly, it is essential to being able to differentiate between these two diseases. Therefore, we performed multiplex reverse transcriptase-polymerase chain reaction and tissue-Doppler echocardiography to distinguish between adenovirus patients and KD patients. METHODS: A total of 113 adenoviral infection patients (female 48, male 65) diagnosed from January 2010 to June 2016 were evaluated. We divided adenoviral infection patients into two groups: group 1, which consisted of individuals diagnosed with KD according to the KD American Heart Association criteria (n=62, KD with adenovirus infection); and group 2, which comprised individuals only diagnosed with adenovirus infection (n=51). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide. Echocardiographic measurements were compared between two groups. In addition, reverse transcriptase-polymerase chain reaction was performed using nasopharyngeal secretions to diagnose adenoviral infection. RESULTS: Conjunctival injection, cervical lymphadenopathy, polymorphous skin rash, abnormalities of the lip or oral mucosa and abnormalities of extremities were significantly higher in group 1 than group 2. Moreover, group 1 had significantly higher C-reactive protein and alanine aminotransferase levels, as well as lower platelet counts and albumin levels than group 2. Coronary artery diameter was significantly greater in group 1 than group 2. CONCLUSION: In patients with adenoviral infection with unexplained prolonged fever, echocardiography and C-reactive protein can be used to differentiate KD with adenoviral infection from adenoviral infection alone.
Adenoviridae ; Adenoviridae Infections ; Alanine Transaminase ; American Heart Association ; C-Reactive Protein ; Coronary Vessels ; Diagnosis, Differential ; Echocardiography ; Exanthema ; Extremities ; Fever ; Humans ; Lip ; Lymphatic Diseases ; Male ; Mouth Mucosa ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Polymerase Chain Reaction