• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.274-282
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• 2003

Background : Tuberculous lymphadenitis is one of the most common forms of extrapulmonary tuberculosis. It was recently reported that the treatment for tuberculous lymphadenitis could be shortened to 6 months without increasing the risk of a relapse. However, there is no report of a prospective randomized study on the use of 6-month chemotherapy with HERZ for cervical lymphadenitis, which is regimen recommended in the areas concerned with the initial drug resistance. The aim of this study is to evaluate the efficacy of the 6-month regimen with HERZ for cervical lymphadenitis in areas where there is a high prevalence of drug resistance in Korea. Method : From January 1997 to February 2002, 92 patients with cervical tuberculous lymphadenitis were recruited from Kyungpook national university hospital. Forty-six patients were given the 6-month regimen(2HERZ/4HER) and the other forty-six patients were given the 9-month regimen(2HERZ/7HER). Result : Of the 46 patients given the 6-month regimen, 5 had residual lymph nodes greater than 5 mm after the completion of treatment and 3 had new lymph nodes or an increased lymph node size during the follow-up period. Of the 46 patients in the 9-month regimen, 9 had residual lymph nodes and 8 had new events during the follow-up period. There were no significant differences between the two groups. Conclusion : These results suggest that the 6-month HERZ regimen can be used safely as the initial treatment for tuberculous lymphadenitis in areas with a similar prevalence of drug resistance.

• Biomedical Science Letters
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• v.19 no.2
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• pp.153-157
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• 2013

Although culture is the gold standard method to identify mycobacteria, its use in tuberculous lymphadenitis (TBL) is limited due to formalin fixation of the submitted specimens. We evaluated the performance of quantitative real-time PCR (q-PCR) for Mycobacterium Tuberculosis (MTB) in granulomatous lymphadenitis using formalin-fixed paraffin-embedded (FFPE) tissues. From 2000 to 2010, a total number of 117 cases of lymph node samples with granulomatous inflammation which were surgically removed and fixed in formalin were studied. Hematoxylin & Eosin (H&E) and Ziehl-Neelsen-stained (ZN) slides were reviewed. qPCR using Real TB-Taq$^{(R)}$ was performed for all cases to identify Mycobacterium tuberculosis. Thirteen non-tuberculous lymphadenopathy cases were used as negative control. Cervical lymph nodes were more frequently affected (60%, 70/117) than other sites. ZN stain for acid fast bacilli was positive in 19 (16.24%) cases. qPCR for tuberculosis was positive in 92 (78.63%) cases. Caseous necrosis was found in 103 (88.03%) cases. While the ZN stain and qPCR were both negative in all control cases, the qPCR showed a significantly higher positive rate (78.63% vs. 16.24%) compared to ZN stain in histologically diagnosed TBL. Quantitative real-time PCR proves to be more sensitive than ZN stain for diagnosis of tuberculous lymphadenitis.

• Tuberculosis and Respiratory Diseases
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• v.48 no.5
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• pp.730-739
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• 2000

Background : The aim of this study was to analyze the clinical manifestations and efficacy of treatment regimens in order to determine the adequate combination of anti-tuberculotic agents and duration of treatment for tuberculous lymphadenitis. Methods : We made a review of 373 patients with tuberculous lymphadenitis, who were admitted to four medical college hospitals in Taegu Korea from 1989 to 1998, and their diagnoses were confirmed histologically and bacteriologically. Results : The incidence of tuberculous lymphadenitis was 71.3% in women and 57.7% were between the ages of 20 and 39 years. The most common symptom was painless swelling. The most commonly involved lymph nodes were unilateral superficial cervical lymph node groups. Tuberculous lymphadenitis was accompanied with active pulmonary tuberculosis, commonly. The sensitivity of fine needle aspiration(FNA) in tuberculous lymphadenitis was 79.6%, and 92.2% of the patients had a strong positive reaction to the tuberculin skin test. The most commonly prescribed anti-tuberculotic regimen was the combination of INH, RMP, EMB, and PZA(62.6 %). Eighty percent of patient were treated for 9-12 months. There was no significantly difference in the recurrence rate of tuberculous lymphadenitis between the combinations of anti-tuberculotic agent, including INH and RMP, and between the durations of treatment, for a period of 6 months of more. Conclusion : The combination of FNA cytologic examination and tuberculin skin test may be helpful in the diagnosis of tuberculous lymphadenitis. We propose that the combination of anti-tuberculotic agents, INH, RMP, EMB, and PZA, be prescribed to patients for 6 to 9 months.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.169-176
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• 1996

Tuberculous cervical lymphadenitis is still an important cause of neck mass in Korea. Tuberculosis is an important differential diagnosis in patients of cervical lymphadenopathy. Rapid and sensitive test for the diagnosis of tuberculosis is essential for the approapiate treatment. Up to now, conventional diagnostic methods for M. tuberculosis were acid-fast bacilli(AFB) stain and culture of M. tuberculosis. The direct microscopic examination of AFB by Ziehl-Neelsen stain is rapid, but often negative. The culture for M. tuberculosis is time-consuming, taking 4 to 8 weeks. Recently various methods to detect Mycobacterial DNA, including PCR and restriction fragment length polymorphism(RFLP) analysis have been reported. Here we represent a simple method for the confirmation of M. tuberculosis and exclusion of the other Mycobacterial species by RFLP analysis and silver staining of polyacrylamide gel electrophoresis after nested PCR for a repetitive DNA sequence(IS986) specific for M. tuberculosis from fresh or paraffin-embedded biopsy specimens. This result leads us to conclude that this method is simple, rapid and possibly applicable to confirm M. tuberculosis and rule out the other Mycobacteria species from the clinical specimens in the clinical laboratories.

• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.503-508
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• 1998

Background: Tuberculous cervical lymphadenitis is one of the common causes of cervical mass in adult (especially in woman) in korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous chemotherapy. Method: To clarify the proper duration and/or combination of regimens, we analyzed the clinical data of 31 patient with cervical lymphadenitis diagnosed at Chungnam National University Hospital from March 1996 to December 1996 and all patients were prospectively randomized into two groups(2HREZ/4HRE and 6HREZ) by treatment method. Result: Prevalent age, male to female ratio, association with pulmonary tuberculosis and history of previous antituberculous medication were not statistically different between two groups. The average size of the largest lymph node before teatment was $2.43{\pm}0.98cm$ and $3.15{\pm}1.74cm$, respectively and was 0.63cm and 0.6cm after treatment, respectively. In both groups, 2 patients have engrowing node or not changed node during tratment and no recurrence was found during follow up period upto 12 months. In both groups, no significant side reaction resulting in discotinuation or changing the regimens was noticed. Conclusion: Short course antituberculosis therapy(2HREZ/4HRE) could be recommanded as effective standard therapy for superficial lymph node tuberculosis. Longterm follow up at least 36 months to observe recurrence might be needed to confirm this conclusion.

• The Journal of the Korean bone and joint tumor society
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• v.12 no.2
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• pp.171-175
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• 2006

The involvement in the spine of eosinophilic granuloma is not common. Especially, involvement of cervical spine and posterior neural arch is quite rare. In addition, radiographic findings including magnetic resonance images of eosinophilic granuloma are manifested as vertebral body collapse, loss of pedicle and paravertebral soft mass formation; it must be differentiated with other conditions, such as malignant bone tumor, metastatic cancer or tuberculous spondylitis. We experienced three cases of eosinophilic granuloma involving posterior neural arch of C4, C7, and body of C4 respectively, which were performed surgical treatment and achieved complete healing. We report these cases with review of literatures.

• 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.

• Korean Journal of Bronchoesophagology
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• v.2 no.2
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• pp.268-273
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• 1996

Cystic lesions of the neck are frequently encountered on clinical basis. The usual differential diagnosis includes branchial cleft, cystic hygroma, dermoid cyst, tuberculous lymphadenitis, benign detached goiterous thyroid cyst, and Cavitation epidermoid carcinoma. Most of cysts are benign and malignant cysts are rare. The most common form of cystic malignancy in the lateral neck is cystic degeneration of epidermoid carcinoma metastatic to cervical lymph nodes. Cystic neoplasia may result from malingnant changes occurring within the wall of a previously benign cyst Complete head and neck examination on the primary focus is important Especially, when palpation of thyroid is negative, thyroid carcinoma is easily overlooked. Recently, we experienced papillary carcinoma of the thyroid seen as lateral neck cyst. So we report this case with review of literatures.

• Korean Journal of Bronchoesophagology
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• v.14 no.2
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• pp.64-69
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• 2008

Craniovertebral junction (CVJ) tuberculosis is a rare disease, and potentially fatal due to the risk of atlantoaxial dislocation. The disease usually accompanies a retropharyngeal cold abscess, which can cause subsequential otolaryngologic symptoms such asdysphagia, odynophagia, or airway obstruction. Such a patient must be handled with great care to avoid a disaster. The disease is diagnosed with microbiological or other laboratory tests on the pus collected through puncture and aspiration, which will need otolaryngologic skills. For treatment, otolaryngologists play an important role by doing incision and drainage of the retropharyngeal abscess, or by attending the transoral vertebra surgery as partners with spine surgeons who will manage the CVJ lesions and ensure the craniocervical stability.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.855-858
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• 1985

The mediastinoscopy was a well known useful diagnostic tool for detection of mediastinal lymph nodes invasion by bronchogenic carcinoma, and also useful means for histologic diagnosis of metastatic carcinoma and certain mediastinal tumors. 31 cases of mediastinoscopies were reviewed which were experienced at Kyung Hee University Hospital from July, 1979 to June, 1985. We experienced 20 cervical mediastinoscopies, 10 left anterior mediastinotomy, and 1 both procedures. Of the 31 cases, 22 cases were used for preoperative staging of bronchogenic carcinoma, 7 cases for mediastinal tumor diagnosis, and 2 cases for histologic diagnosis of metastatic carcinoma. In 22 mediastinoscopies which were used for preoperative staging, 10 cases were revealed positive mediastinal nodes, and could avoid meaningless thoracotomy. All 12 mediastinoscopy negative patients were received thoracotomy, and 10 of them were resectable. The resectability in bronchogenic carcinoma was 83%, on the contrary, the other series at premediastinoscopic era revealed only 65% resectability. Other mediastinal lesions such as tuberculous granuloma [4], sarcoidosis [2], malignant thymoma [1], and metastatic carcinoma [2] were also diagnosed successfully. Mediastinoscopy is very useful tool for determination of treating method of bronchogenic carcinoma, and for diagnosis of certain mediastinal tumors which, otherwise, need a thoracotomy for confirmatory diagnosis.