Qap (Anatomical Pathology) 

QAP Peer Review

AP180
Case History: M/65, Multiple cervical lymphadenopathy
Intended diagnosis: Granulomatous inflammation, suggestive of syphilitic lymphadenitis. Contributed by:MST
Code Diagnosis Comment Score
anonymous Granulomatous inflammation (100%) To perform special stains, including ZN, grocott, wade-fite, Warthin-starry stains, to look for organisms.  95
anonymous Granulomatous lymphadenitis with florid follicular hyperplasia, toxoplasmosis is most likely, brucellosis and mycobacterium infection must be ruled out. Serologic studies, special stain and molecular genetic study if necessary.  90
anonymous Non-necrotizing granulomatous inflammation, to exclude infection. Additional clinical history required. Special stains for infective organisms (ZN, Grocott, WS).  95
anonymous Reactive change with follicular hyperplasia and granulomatous inflammation. Perform special studies for organisms (ZN/ Wade-Fite for acid-fast bacilli; Grocott/ PAS-diastase for fungus, immunostaining for cat-scratch disease organism)  90
anonymous Granulomatous lymphadenitis. 100% Special stains eg. ZN and Grocott to look for acid fast bacilli and fungi. Correlate with clinical and culture results for microorganisms. After exclusion of other causes, sarcoidosis is a possibility.  90
anonymous Histiocytic/dendritic cell lesion. (100%) Do CD21 & CD35 to exclude follicular dendritic cell sarcoma. Do S100 protein to exclude Rosai-Dorfman disease. Do Ziehl Neelsen and Wade Fite stains to exclude mycobacterial infection. Do Grocott and PAS stains to exclude fungal infection. Do Warthin Starry stain to exclude syphilis.  20
anonymous Granulomatous lymphadenitis 100% Sarcoidosis is considered after exclusion of mycobacterial or fungal infections.  90
anonymous Granulomatous lymphadenitis (100%) DD'x include 1) infection, 2) other causes of granulomatous inflammation, 3)sarcoid (rare in this locality) and 4) tumours like metastatic carcinoma and Hodgkin's lymphoma (unlikely here). 1) & 2) Perform stains for micro-organisms : Ziehl Neelsen, Gram, PAS, Grocott, Warthin Starry to look for organisms. 4) Perform epithelial marker to exclude minute metastatic carcinoma, examine more blocks to look for minute foci of malignancy.  95
anonymous Granulomatous lymphadenopathy Perform special stains to exclude infectious agents  90
anonymous GRANULOMATOUS INFLAMMATION (100%) Toxoplasmosis needs to be excluded by serology. Ziehl-Neelsen and Grocott stains to exclude mycobacterial and fungal infections. If all negative, sarcoidosis need to be considered.  90
anonymous Granulomatous inflammation 100% cytokeratin to exclude subtle NPC organism stains (ZN, PAS) to exclude TB clinical correlation to exclude sarcoidosis  90
anonymous Granulomatous inflammation Possiblities include infection, reaction to occult tumor and reaction to foreign body. Suggest Ziehl-Neelsen, Wade-Fite and fungal stains to detect specific infectious organisms.  90
anonymous Granulomatous inflammation. Do PASD and ZN stain to look for fungus and mycobacterium. Probability: 100% nil  90
anonymous Granulomatous inflammation (100%), favour infective etiology Infective cause is favoured. Perform special stains for fungus, acid fast bacilli and spirochaetes. Correlate with microbiological studies.  95
anonymous Granulomatous inflammation (100%) Special stains including ZN and PASD for infective organisms. Sarcoidosis is a likely diagnosis if all stains are negative and clincially consistent.  90