20 yr Female cough and wt loss for 1 month no fever sputum AFB neg cervical lymphnode fna showed necrosis no granuloma and AFB STAIN negative?

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Bilateral Cervical and mediastinal lympadenopathy.. No fever.. D/D already discussed by my fellow doctors I feel before going for other invasive procedure like Ebus or tbna.. Approachable Cervical gland tissues should be obtained for histopathology.. It may clinch the diagnosis.. It will provide good amount of tissue material.. Which is not possible in FNAC. Other pathological tests will be all indicative and may not help in definitive diagnosis

your opinion is valuable sir , we explore that possibility of taking excision biopsy of cervical lymphnode but it is engulfing the neck vessels so not possible as per surgeon.
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bilateral massive lymphadenopathy... bronchoscopy tbna can be done in such cases.. or CT guided biopsy is also feasible.. for histopath ..afb smear culture.. montoux test ..esr.. SR.ace levels to be checked.. differentials tb sarcoid lymphoma

extensive lymphadenopathy in cervical and mediastinal region... With few areas of central necrisosis although contrast scan are not availbl ... lesion is quite typically located in middle and posterior mediastinum as is evident on xray as well as hrct thorax ... No endobronchial obstruction evident on dese sections . Go ahead with Ct guided biopsy of mediastinal lymph nodes/ usg guided trucut biopsy of cervical nodes ... send sample for Gene xprt afb smear and culture histopathology ... Possibble D/D are Tb Sarcoidosis lymphoma Rule out hiv as well Malignancy if other common diagnosis are ruled out then in young girls condition can also be kikuchi fujimoto diseas ... Wich is a self remitting disease !!!

FNAC is a blind procedure.. It may aspirate from the central necrosis and not from the histopathologically significant peripheral part.. There are instance where FNAC is negative but biopsy material clinched the diagnosis..

Repeat fnac from significant Cervical lympadenopathy may be valuable

sir are cervical lymph nodes significant, if fna is non specific, we can go for biopsy which gives us more yield, can do gene xpert 2.paratracheal LN stations also shows adenopathy,can go for EBUS FNA 3.Mantoux if negative sarcoidosis can be suspected

RT paratracheal B/L LYMPHADENOPATHY may s/o SARCOIDOSIS. bur cervical lymph nodes no granuloma if non caseating s/o sarcoidosis. TST should be done if negative sarcoidosis can be ruled out. plan for bronchoscopy with biopsy lymphoma also has to ruled out as necrotic can be TB r LYMPHOMA. AFB stain negative tb can be ruled out, but if fna for genexpert is also negative for tb them very can ruled out tb. as tb more common in india

agree wit Dr podar sir..however d size of cervical lymph nodes not mentioned here..if big models thn dats d most easy approach..

If Cervical gland is significantly sized repeat FNAC may also help.. May negate the need for other invasive procedure..

CECT thorax along with repeat FNAC Cx LN should be done as it sometime maybe helpful. It looks to be lymphoma.

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