• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.957-963
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• 1997

결핵성 임파선염은 아직도 한국에서 많이보는 질환이며 젊은여자 성인 특히 아시아인이나 흑인에서 가장 흔하다. 이 질환은 두경부에 흔히 무통성으로 서서히 림프절이 커지는 양상을 보이나 인체내 결절이 있는 어디나 오며 종격동 결절에도 온다. scrofula(선통(腺病))는 다양한 종양, 비종양성 종괴, 감염질환 특히 경부임파선염 풍과 구별되야만 한다. 비록 병력, 역학, 임상양상 흉부 엑스선 그리고 결핵반응검사로써 만족할만한 진단을 내리지만 절제생검으로 조직 및 배양이 필요하기도 하다. 궤양이나 만성 누공 형성을 막기위해 부분생검이나 절개 및 배농은 반드시 피해야 한다. 치료는 항결핵화학요법이며 가끔 외과적 적출술이 약물요법과 더불어 요구되기도 한다.

• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.505-513
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• 2004

Background : In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. Methods and Materials : From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (${\geq}5mm$ in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. Results : Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. Conclusions : USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.294-298
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• 2006

Lymphocytic interstitial pneumonia(LIP) is an uncommon condition in which the alveolar septa and extra-alveolar interstitial space are markedly expanded by small lymphocytes, plasma cells and histiocytes. Chest radiographs generally show nonspecific patterns with the most common pattern showing bibasilar reticular or reticulonodular infiltrates. Hilar or mediastinal lymphadenopathy and pleural effusions are usually absent. We encountered a 42-year-old female patient who was admitted to hospital because of exertional dyspnea and palpitation. The chest X-ray showed an enlarged bilateral hilar shadow and diffusely increased bronchovascular markings in both lung fields. The chest CT showed diffuse nodular infiltrations with mild septal thickening and combined patchy ground glass opacity in both lungs, and conglomerated mediastinal and bilateral hilar lymphadenopathy. A diagnosis of LIP was made from the tissue pathology taken by a thoracoscopic lung biopsy. The patient showed clinical and radiographic improvement after 3 months of treatment with prednisolone. We report a case of LIP presenting as diffuse nodular interstitial infiltrations with multiple mediastinal and bilateral hilar lymphadenopathy.

• Tuberculosis and Respiratory Diseases
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• v.62 no.6
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• pp.536-539
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• 2007

Lymphadenitis is a common manifestation in tuberculous diseases. However, papulonecrotic tuberculid is an uncommon cutaneous manifestation, and is considered an allergic reaction against tuberculous bacilli in tuberculous lesions other than the lymph nodes. A wide great variety of cutaneous manifestations arise over a period of a few weeks - i.e., papules, necrosis, crusted and atrophic scars. We described a 27-year-old woman with right cervical tuberculous lymphadenitis and skin lesions involving her arms, legs and both fingers. Histopathologically, a leukocytoclastic vasculitis with V-shaped epidermal necrosis was observed in the upper and deep dermis, including the good response to anti-tuberculosis therapy support the diagnosis of papulonecrotic tuberculid.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.194-199
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• 2007

BALT(bronchial associated lymphoid tissue) lymphomas are a distinct subgroup of low-grade B-cell extranodal non-Hodgkin's lymphoma, which are classified as a marginal-zone lymphomas. The majority of the patients are asymptomatic or their pulmonary lesions is often discovered incidentally on a routine chest radiograph. A 50-year-old man was admitted for an the evaluation of cough, dyspnea and fever. His chest CT showed ground glass appearance with interlobular septal thickening in both lower lobes, right middle lobe and left lingular division. He had been initially diagnosed with lipoid pneumonia and was kept under observation. However, his chest lesion showed continuous progression and a video-associated thoracoscopy was performed His pulmonary lesion was confirmed histologically to be a BALT(bronchial associated lymphoid tissue) lymphoma. We report a case of a BALT lymphoma, which was initially misdiagnosed as lipoid pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.345-350
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• 2004

Background : To evaluate the frequency and clinical significance of lymph node micrometastasis in patients of non-small-cell lung cancer pathologically staged to be T1-2,N0. Method : From consecutive 29 patients of non-small-cell lung cancer who received curative operation and routine systemic nodal dissection, we immunohistochemically examined 806 lymph nodes from mediastinal, hilar and peribronchial lesion. All slides were stained with hematoxylin and eosin staining for one section and with cytokeratin AE1/AE3 antibody for another consecutive section of same lymph node to find out micrometastasis. Results : In 806 lymph nodes examined, no tumor cell was seen on hematoxylin and eosin staining and micrometastic foci were shown to be on 0.37%(3) of 806 lymph nodes, in which were upper paratracheal, interlobar and peribronchial lymph node. These three positive stains constitute 10.3%(3) of the 29 patients with non-small-cell lung cancer. Nine patients died from disease progression(4), postoperative complication(3) and concomitant diseases(2). The four patients with disease progression did not show evidence of micrometastasis on their lymph node examination. Conclusion : The frequency of lymph node micrometastasis was in 0.37% of 806 lymph nodes examined. The study results might suggested that routine analysis of micrometastasis on the lymph node didn't give any clinical implication on patients with non-small-cell lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.47 no.5
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• pp.642-649
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• 1999

Background: It is very important to determine an accurate staging of the non-small cell lung cancer(NSCLC) for an assessment of operability and it's prognosis. However, it is difficult to evaluate tumor involvement of mediastinal lymph nodes accurately utilizing noninvasive imaging modalities. PET is one of the sensitive and specific imaging modality. Unfortunately PET is limited use because of prohibitive cost involved with it's operation. Recently hybrid SPECT/PET(single photon emission computed tomography/positron emission tomography) camera based PET imaging was introduced with relatively low cost. We evaluated the usefulness of coincidence detection(CoDe) PET in the detection of metastasis to the mediastinal lymph nodes in patients with NSCLC. Methods: Twenty one patients with NSCLC were evaluated by CT or MRI and they were considered operable. CoDe PET was performed in all 21 patients prior to surgery. Tomographic slices of axial, coronal and sagittal planes were visually analysed. At surgery, mediastinal lymph nodes were removed and histological diagnosis was performed. CoDe PET findings were correlated with histological findings. Results: Twenty of 21 primary tumor masses were detected by the CoDe PET. Thirteen of 21 patients was correctly diagnosed mediastinal lymph node metastasis by the CoDe PET. Pathological N0 was 14 cases and the specificity of N0 of CoDe PET was 64.3%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N1 node was 83.3%, 73.3%, 55.6%, 91.7%, and 76.2% respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N2 node was 60.0%, 87.5%, 60.0%,87.5%, and 90.0% respectively. There were 3 false negative cases but the size of the 3 nodes were less than 1cm. The size of true positive nodes were 1.1cm, 1.0cm, 0.5cm respectively. There were 1 false positive among the 12 lymph nodes which were larger than 1cm. False positive cases consisted of 1 tuberculosis case, 1 pneumoconiosis case and 1 anthracosis case. Conclusion: CoDe PET has relatively high negative predictive value in the enlarged lymph node in staging of mediastinal nodes in patients with NSCLC. Therefore CoDe PET is useful in ruling out metastasis of enlarged N3 nodes. However, further study is needed including more number of patients in the future.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.694-699
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• 2010

Background: In addition to clinical and radiographic findings, a histopathologic examination is important in the diagnosis of sarcoidosis. This study evaluated the diagnostic usefulness of a scalene node biopsy in patients with suspected sarcoidosis. Material and Method: We studied 35 patients who underwent scalene node biopsy because of suspicion of sarcoidosis on a chest x-ray and a computerized tomogram between 2001 and 2009, regardless of symptoms. Result We studied 15 men and 20 women whose mean age was $41.51{\pm}11.21$ years (25~64). Three among the 35 were diagnosed with tuberculosis and 27 with sarcoidosis, resulting in a diagnostic yield of 84.4%. The mean lymph node diameter size was 1.3 (${\pm}0.12$) (0.3~3.6 cm) cm. We divided the group of participants according to stage - whether on chest x-ray the lung was affected or not (stage 0, 1 and stage 2, 3). We divided lymph node sizes as well - whether they were larger than 1 cm or smaller than 1 cm. For these subgroups, there were no significant differences in diagnostic yield (p=0.604) (p=0.084). There were no complications or mortality. Conclusion: Scalene node biopsies are simply done under local anesthesia, without major complications. They have a high diagnostic yield regardless of the stages of the disease and lymph node size. We conclude that scalene node biopsy is a good alternative to other biopsy methods in sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.879-883
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• 1999

The lymphoid system of the lung represents a complex network of lymphoid tissue and lymphatic vessels. Lymph nodes are normally located in the hila, adjacent to the lobar bronchi and within the lung to the level of the fourth-order bronchi. Clinically apparent intrapulmonary lymph nodes are rare. Although of intrapulmonary lymph node histogenesis is uncertain, They are probably hyperplastic lymphoid nodules related to inhalation of irritant dusts and attendant distortion of local lymphatic vessels. Intrapulmonary lymph nodes are detected as solitary or multiple pulmonary nodules. These nodules are difficult to differentiate from intrapulmonary metastasis by radiologic finding. We experienced a case of intrapulmonary lymph nodes presenting multiple nodules in a 46 years old man, which was confirmed by thoracoscopic biopsy.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.91-96
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• 2011

Bacille Calmette-Gu$\acute{e}$rin (BCG) vaccine is a live attenuated vaccine derived from Mycobacterium bovis. Frequent complications after BCG vaccination are localized ulcer formation and regional lymphadenitis, but there could be rarely severe systemic reactions to BCG vaccine such as osteomyelitis and disseminated BCG infection. Although disseminated BCG infection can be complicated in infants with underlying immunodeficiency after BCG vaccination, it is very unlikely to develop in immunocompetent infants or children. We report a 13-month-old infant who presented with fever, skin nodules, and multiple enlarged lymph nodes 5 months following BCG vaccination. She was diagnosed with disseminated BCG infection by PCRconfirmed M. bovis BCG infection at ${\geq}$2 anatomical sites beyond the region of vaccination. The patient showed no obvious evidence of immunodeficiency as judged on the basis of previous disease history, plasma immunoglobulin levels, B and T lymphocytes counts in peripheral blood, DHR (dihydrorhodamine 123 fluorescence) test and HIV test. She started antituberculous treatment with isoniazid and rifampin, and now, apparently her symptoms have been improved.