This study demonstrates the excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis. The test sensitivity and specificity were 96.7% (95% confidence interval [CI], 86.6 to 100%) and 88.9% (95% CI, 69.6 to 100%), respectively, and it correctly identified 6/6 (100%) of the cytology smear-negative/culture-positive cases and 1 of 2 (50%) rifampin-resistant cases.Tuberculous lymphadenitis is the most common extrapulmonary manifestation of tuberculosis (TB) (4,8), and the majority of cases have no active lung involvement. Fineneedle aspiration biopsy (FNAB) offers a feasible and safe option for specimen collection (11,15). The use of cytology together with the confirmation of acid fastness by ZiehlNeelsen (ZN) staining and Papanicolaou stain-induced fluorescence microscopy as well as mycobacterial detection by culture offers excellent yields (13, 14) but remains limited by the absence of species confirmation, slow turnaround times, and/or lack of drug resistance guidance. Conventional microbiological culture and drug susceptibility testing are not always available and in rare instances may take 6 weeks or longer (10).The World Health Organization (WHO)-endorsed Xpert MTB/RIF combines sample processing and real-time PCR in a fully automated platform and detects Mycobacterium tuberculosis complex and rifampin resistance in less than 2 h (2, 3, 9). Xpert MTB/RIF has been used successfully on various extrapulmonary specimens, including urine and stool (6), but has not been rigorously evaluated with the use of tissue specimens, such as FNAB specimens.To determine the diagnostic utility of the Xpert MTB/RIF, FNAB specimens were collected from 50 consenting patients by aspirating two passes of a 23-or 25-gauge needle attached to a 10-ml syringe. Two smears were prepared from each aspirate, one fixed with commercial cytology fixative for Papanicolaou staining and evaluation by fluorescence microscopy and the other air dried for Giemsa and subsequent ZN staining.Smears were evaluated for adequacy and for a morphological diagnosis, and cases were excluded from the analysis if either one or both passes had inadequate cellular material on smears. Both ZN and Papanicolaou stain-induced fluorescence microscopy evaluations were performed for direct detection of mycobacteria on all specimens. Residual material from one of the aspirates was rinsed in a mycobacterial growth indicator tube (MGIT 960; Becton Dickinson) by aspirating a small volume of fluid into the syringe and expressing it back into the MGIT 960 tube, followed by incubation in a MGIT 960 instrument for mycobacterial culture. Positive cultures were identified as belonging to the Mycobacterium tuberculosis complex, and genotypic drug susceptibility testing was done using the genotype MTBDRplus assay (Hain Lifescience, Germany) (1).The residual material from the remaining aspirate was rinsed as described above into 0.7 ml sterile phosphate-buffered saline (PBS) in a 10-ml headspace glass vial sealed with a TFE/Sil Septa and alumin...

The association of primary MANEC of the tongue with a gastrointestinal heterotopic cyst supports an origin from entrapped endodermal elements as opposed to salivary duct origin. This case raises the awareness of a rare yet prognostically important complication of a gastrointestinal heterotopic cyst.