{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T10:09:29Z","timestamp":1742378969629},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10,11]]},"abstract":"<jats:p>The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26\u201352), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (<jats:italic>P<\/jats:italic> &lt; 0.05) and gastrointestinal symptoms (<jats:italic>P<\/jats:italic> &lt; 0.05). Abnormalities were reported in 40% of chest X-rays (<jats:italic>N<\/jats:italic> = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (<jats:italic>N<\/jats:italic> = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (<jats:italic>P<\/jats:italic> &lt; 0.001) and lymphoma less common (<jats:italic>P<\/jats:italic> = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, <jats:italic>P<\/jats:italic> = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0961","type":"journal-article","created":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T07:00:16Z","timestamp":1503385216000},"page":"1271-1276","source":"Crossref","is-referenced-by-count":4,"title":["Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru"],"prefix":"10.4269","volume":"97","author":[{"given":"Daniela E.","family":"Kirwan","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, St. George\u2019s Hospital, London, United Kingdom;"},{"name":"Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom;"},{"name":"Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar","family":"Ugarte-Gil","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;"},{"name":"Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert H.","family":"Gilman","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University, Baltimore, Maryland;"},{"name":"Laboratorio de Investigaci\u00f3n en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed M.","family":"Hasan Rizvi","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Cerrillo","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Cok","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital Nacional Cayetano Heredia, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Ticona","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos De Mayo, Lima, Peru;"},{"name":"Department of Medicine, Universidad de San Marcos, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Luis","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Hospital Daniel Alcides Carri\u00f3n, Callao, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo D.","family":"Matos","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nacional Arzobispo Loayza, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlton A.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom;"},{"name":"Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom;"},{"name":"Innovation for Health and Development, Laboratory of Research and Development (IFHAD), Universidad Peruana Cayetano Heredia, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A. J.","family":"Moore","sequence":"additional","affiliation":[{"name":"TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon S.","family":"Friedland;","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom;"},{"name":"Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, St. George\u2019s Hospital, London, United Kingdom;"},{"name":"Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom;"},{"name":"Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom;"},{"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;"},{"name":"Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Swiss Med Wkly","first-page":"98","article-title":"Peripheral lymphadenopathy in immunocompetent adults","volume":"140","author":"Richner","year":"2010"},{"year":"1993","author":"Pangalis","key":"b2"},{"key":"b3","series-title":"Pediatr Surg Int","first-page":"240","article-title":"Diagnostic aspects of cervical lymphadenopathy in children in the developing world: a study of 1,877 surgical specimens","volume":"19","author":"Moore","year":"2003"},{"key":"b4","series-title":"BMC Health Serv Res","first-page":"1","article-title":"Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients","volume":"11","author":"Hansen","year":"2011"},{"key":"b5","series-title":"N Engl J Med","first-page":"1539","article-title":"Microscopic-observation drug-susceptibility assay for the diagnosis of TB","volume":"355","author":"Moore","year":"2006"},{"key":"b6","series-title":"J Clin Microbiol","first-page":"185","article-title":"Microscopic observation drug susceptibility (MODS) for rapid diagnosis of lymph node tuberculosis and detection of drug resistance","volume":"54","author":"Kirwan","year":"2015"},{"key":"b7","series-title":"Biometrics","first-page":"159","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977"},{"key":"b8","series-title":"Clin Infect Dis","first-page":"855","article-title":"Clinical evaluation of a 16S ribosomal RNA polymerase chain reaction test for the diagnosis of lymph node tuberculosis","volume":"43","author":"Osores","year":"2006"},{"key":"b9","series-title":"Asian Pac J Cancer Prev","first-page":"4677","article-title":"Pattern of lymph node pathology in western Saudi Arabia","volume":"15","author":"Albasri","year":"2014"},{"key":"b10","series-title":"J Pak Med Assoc","first-page":"405","article-title":"Peripheral lymphadenopathy in Nigerial adults","volume":"56","author":"Olu-Eddo","year":"2006"},{"key":"b11","series-title":"Pan Afr Med J","article-title":"Diagnostic evaluation of primary cervical adenopathies in a developing country","volume":"10:","author":"Olu-Eddo","year":"2011"},{"key":"b12","series-title":"Niger Postgrad Med J","first-page":"299","article-title":"Surgical lymph node biopsies in University of Ilorin Teaching Hospital, Ilorin, Nigeria","volume":"12","author":"Ojo","year":"2005"},{"key":"b13","series-title":"Med Sante Trop","first-page":"304","article-title":"Profile of adenopathies in a tropical setting: 78 observations in Gabon","volume":"23","author":"Ondounda","year":"2013"},{"key":"b14","series-title":"Saudi Med J","first-page":"282","article-title":"Lymphadenopathy in adults. A clinicopathological analysis","volume":"23","author":"Abba","year":"2002"},{"key":"b15","series-title":"Br J Cancer","first-page":"354","article-title":"Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients","volume":"88","author":"Chau","year":"2003"},{"key":"b16","series-title":"Eur Arch Otorhinolaryngol","first-page":"745","article-title":"Cervical lymphadenopathy: study of 251 patients","volume":"272","author":"Al Kadah","year":"2015"},{"key":"b17","series-title":"Arch Pathol Lab Med","first-page":"326","article-title":"Comparison of polymerase chain reaction with histopathologic features for diagnosis of tuberculosis in formalin-fixed, paraffin-embedded histologic specimens","volume":"127","author":"Park","year":"2003"},{"key":"b18","series-title":"Diagn Cytopathol","first-page":"75","article-title":"Comparative cytological study of lymph node tuberculosis in HIV-infected individuals and in patients with diabetes in a developing country","volume":"26","author":"Sridhar","year":"2002"},{"key":"b19","series-title":"Hum Pathol","first-page":"153","article-title":"Cavitary pulmonary coccidioidomycosis: pathologic and clinical correlates of disease","volume":"45","author":"Sobonya","year":"2014"},{"key":"b20","series-title":"Int J Tuberc Lung Dis","first-page":"1396","article-title":"The WHO\/IUATD diagnostic algorithm for tuberculosis and empiric fluoroquinolone use: potential pitfalls","volume":"8","author":"Sterling","year":"2004"},{"key":"b21","series-title":"Pathol Res Pract","first-page":"155","article-title":"Lung granulomas from Mycobacterium tuberculosis\/HIV-1 co-infected patients display decreased in situ TNF production","volume":"204","author":"de Noronha","year":"2008"},{"year":"2014","author":"Silva","key":"b22"},{"year":"2008","author":"Lawn","key":"b23"},{"key":"b24","series-title":"Lancet Infect Dis","first-page":"251","article-title":"Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis","volume":"10","author":"Muller","year":"2010"},{"key":"b25","series-title":"Pathol Res Pract","first-page":"767","article-title":"Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru","volume":"202","author":"Eza","year":"2006"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/4\/article-p1271.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/4\/article-p1271.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/4\/article-p1271.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T22:46:04Z","timestamp":1722465964000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/4\/article-p1271.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,11]]},"references-count":25,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0961","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2017,10,11]]}}}