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Abstract
Background:
In principle, cervical tuberculous lymphadenitis (CTBL) is a medical disease that may require surgical treatment, particularly in young women who complain of psychosocial and cosmetic problems. We encountered 13 cases of aggravated CTBL treated surgically despite the appropriate course of antituberculous chemotherapy. We report the clinical characteristis of these cases.
Methods:
The clinical data of 13 patients with aggravated CTBL requiring surgical treatment from January 2000 to December 2006 at the Department of Chest Medicine, Internal Medicine and Plastic Surgery, National Medical Center was reviewed retrospectively.
Results:
Twelve of the 13 cases (92%) were female. The most common age was 21~30 years (69%). Multiple nodes were palpated in 11 cases (85%). The supraclavicular lymph nodes were sites the most commonly involved (54%). The other involved sites in the order of decreasing frequency were the jugular chain, posterior cervical, submandibular and infraauricular lymph nodes. A palpable mass was the most commonsymptom. Neck pain was reported in 3 cases (23%). General symptoms such as weight loss, fatigue, anorexia and night sweats were noted in 5 cases (38%). Respiratory symptoms such as cough, sputum, hemoptysis, dyspnea and chest pain were observed in 4 cases (31%). Pulmonary tuberculosis was noted in 11 cases (85%). Other extrapulmonary tuberculosis coexisted in 4 cases (31%). This suggests that surgical CTBLs may be manifestations of a systemic disease and might be difficult to treat. Most cases (92%) were stages 2 and 3 at the initial diagnostic period but all cases fell into stage 4 and 5 when reassesed before surgery. The average duration of anti-TB chemotherapy before and after surgery was 10.2 and 15.2 months, respectively. The 13 patients were followed up until June. 2008. Among them, 2 cases had newly developed CTBL and the other 11cases showed no recurrence.
Conclusion:
In principle, CTBL is the medical disease. However, despite the appropriate course of anti-TB chemotherapy, CTBL can progress to a more advanced stages and grow rapidly to a large-sized or fistulous mass with a persistent abscess. Surgical treatment may be inevitable for patients with psychosocial and cosmetic problems caused by these masses, particularly in young women.
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Figure 1.
Comparison of lesion before (left panels) and after surgical treatment (right panels). (A) This 27 year old female patient with CTBL had taken anti-TB drugs for 4 months before excision. At 2 months after excision, the lesion was improved. (B) This was a case of recurred CTBL with abscess and fistula formation. This 26 year old female had taken anti-TB drugs for 8 months. But, CTBL progressed and formed abscess and fistula. At 1 month after excision, the lesion was improved.
Table 1.
Sex and age distribution of patients with ad vanced CTBL
| No. of patients (%) | |
|---|---|
| Sex | |
| Female | 12 (92%) |
| Male | 1 (8%) |
| Age | |
| 11∼20 | 1 (8%) |
| 21∼30 | 9 (69%) |
| 31∼40 | 3 (23%) |
| Total | 13 (100%) |
Table 2.
Involved site of CTBL
| Site | No. of patients (%) |
|---|---|
| Supraclavicular | 7/13 (54%) |
| Posterior cervical | 5/13 (38%) |
| Jugular chain | 6/13 (46%) |
| Submandibular | 2/13 (15%) |
| Infraauricular | 1/13 (8%) |
Table 3.
Presenting symptoms of CTBL
| Symptoms | No. of patients (%) |
|---|---|
| Neck pain | 3/13 (23%) |
| General symptoms∗ | 5/13 (38%) |
| Respiratory symptoms† | 4/13 (31%) |
| General and respiratory symptoms | 3/13 (23%) |
Table 4.
Patients with pulmonary or extrapulmonary TB except CTBL
| Associated diseases | No. of patients (%) |
|---|---|
| Pulmonary TB | 11/13 (85%) |
| Extrapulmonary TB except CTBL | 4/13 (31%) |
| Pulmonary and extrapulmonary TB except CTBL | 3/13 (23%) |
Table 5.
Number of patients with extrapulmonary TB in surgical CTBL
| Name of extrapulmonary TB | No. of patients (%) |
|---|---|
| Mediastinal lymphadenitis | 3/4 (75%) |
| TB pleurisy | 2/4 (50%) |
| Pericardial TB | 1/4 (25%) |
Table 6.
Number of patients according to the stage of lymphadenopathy by Jones and Campbell's criteria
| Stage | No. of patients (%) | |
|---|---|---|
| Initial diagnostic period | Surgical treatment period | |
| Stage 1 | 1 (8%) | |
| Stage 2 | 9 (69%) | |
| Stage 3 | 3 (23%) | |
| Stage 4 | 6 (46%) | |
| Stage 5 | 7 (54%) | |
| Total | 13 (100%) | 13 (100%) |
Table 7.
Results of AFB staining, TB culture and TB-PCR at the time of initial diagnosis in surgical CTBL
| Result | AFB staining (%) | TB culture (%) | TB-PCR (%) |
|---|---|---|---|
| Positive | 8/12 (67%) | 0/5 (0%) | 2/3 (66.7%) |
| Negative | 4/12 (33%) | 5/5 (100%) | 1/3 (33.3%) |
| Total | 12/12 (100%) | 5/5 (100%) | 3/3 (100%) |
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