Clinical Endoscopy

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology: Nonthalee Pausawasdi, Kotchakon Maipang, Tassanee Sriprayoon, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(2):279-286. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.218-IDEN

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

Citations

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JGH Open.2022; 6(11): 745. CrossRef

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A Case of Duodenal Fistula Caused by Intra-abdominal Tuberculous Lymphadenopathy during Anti-tuberculous Medication: Kyong Rok Lee, M.D., Kang Seok Seo, M.D., Jun Ho Cheo, M.D., Sang Cheol Choi, M.D., Kang Kim, M.D., Youn Gun Yim, M.D., Gun Young Hong, M.D. and Sang Wook Park, M.D.; Korean J Gastrointest Endosc 2008;37(6):433-437. Published online December 30, 2008

Abstract PDF: Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication. (Korean J Gastrointest Endosc 2008;37:433-437)

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A Case of Surgical Treatment of Tuberculous Cholangitis and Lymphadenitis with Obstructive Jaundice due to Progressive Stricture of Bile Duct: Kil Hyun Kim, M.D., Yang Suh Ku, M.D., Koen Kuk Kim, M.D.*, Hyun Ok Kim, M.D., Geum Ha Kim, M.D., Kwang Il Ko, M.D., Nak So Chung, M.D., Sang Kyun Yu, M.D., Dong Kyun Park, M.D., Kwang An Kwon, M.D., Yeon Suk Kim, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim,; Korean J Gastrointest Endosc 2007;35(4):287-291. Published online October 30, 2007

Abstract PDF: Obstructive jaundice is most commonly attributed to a malignancy or stones affecting the common bile duct. Biliary tuberculosis and lymphadenitis around the periportal area have also been implicated but cases are quite rare. A 24 year old man presented with jaundice and abdominal pain for 3 days. Abdominal CT and ERCP revealed a stricture of the extrahepatic bile duct with multiple enlarged lymph nodes showing necrotic foci located at the periportal area. The colonoscopic biopsy showed evidence of M. tuberculosis. The patient was treated with ERBD insertion and oral anti-tuberculosis therapy. However, the abdominal pain recurred and there was progressive stenosis of the common bile duct. A bile duct resection with choledochojejunostomy was subsequently performed. Frozen sections revealed granulomatous inflammation with caseation necrosis, which was consistent with tuberculosis. We report a case of tuberculous cholangitis and lymphadenitis with obstructive jaundice that was managed surgically due to the progressive stricture of the bile duct. (Korean J Gastrointest Endosc 2007;35:287-291)

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Choledocho-duodenal Fistula Caused by Tuberculosis: Sang Jeong Yoon, M.D., Byung Min John, M.D., Sung Hee Jung, M.D., Anna Kim, M.D., Byeong Seong Ko, M.D., Hyeon Woong Yang, M.D., Young Sook Park, M.D., Hoon Go, M.D., Gi Young Choi, M.D., Jun Hyoung Kim, M.D., Jae Min Lee, M.D., Hyo Jung Nam, M.D. and Soo; Korean J Gastrointest Endosc 2005;30(5):286-288. Published online May 30, 2005

Abstract PDF: Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures. (Korean J Gastrointest Endosc 2005;30:286⁣289)

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점막하 종양으로 보인 십이지장 결핵에 동반된 결핵성 림프절염 1 예 ( A Case of Duodenal Tuberculosis Conceived as Submucosal Tumor Accompanied by Tuberculous Lymphadenitis ): Korean J Gastrointest Endosc 2001;23(4):230-234. Published online November 30, 2000

Abstract PDF: In spite of decrease in prevalence, yet tuberculosis is not rare disease in Korea and the morbidity is over one percent. Because extrapulmonary tuberculosis is less common than that of lung, quick and accurate diagnosis is not easy and there may be some problems in selecting the methods and the times to treat it. Especially, each or combination of abdominal lymphadenitis and duodenal tuberculosis are so rare that differential diagnosis from other common or rare diseases is difficult, and much attention is required to diagnose and treat those. Recently we experienced a case of tuberculous lymphadenitis accompanied by duodenal bulbar tuberculosis which had been conceived as submu cosal tumor at endoscopy and diagnosed by explorative operation. So we report this case with review of related literatures. (Korean J Gastrointest Endosc 2001;23:230-234)

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증례 : 폐쇄성 황달을 유발한 결핵성 림프선염 1예 ( Case Reports : A Case of Tuberculous Lymphadenitis Causing Obstructive Jaundice ): Korean J Gastrointest Endosc 1994;14(1):115-120. Published online November 30, 1993

Abstract PDF: Obstructive disorders of the biliary trees include occlusions of the bile duct lumen by stones, intrinsic disorders of the bile ducts, and extrinsic compressions. The most common biliary cause of obstructive jaundice is the presence of stones. Intrinsic disorders of the bile ducts may be inflammatory, infectious, or neoplastic. And significant enlargement of adjacent lymph nodes due to metastatic tumors or lymphoma can occasionally obstruct the extrahepatic bile ducts. But obstructive jaundice produced by periportal tuberculous lymphadenitis with no evidence of pulmonary tuberculosis is very rare. We report a case of tuberculous lymphadenitis causing obstructive jaundice with a mass around mid common bile duct on abdominal sonogram, CT scan and ERCP, and it was confirmed by an exploratory laparotomy.

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