A clinicopathological study of peripheral lymphadenopathy in adults

Abstract

Background: Peripheral lymphadenopathy is a very common presenting symptom in clinical practice. Cause may be different in people with and without HIV infection. FNAC of lymph nodes is often diagnostic, however sometimes one has to opt for biopsy. Present study aimed at utilising clinical findings and the different diagnostic modalities to establish the aetiology. Methods & Materials: A total of 100 adult patients with lymphadenopathy (50 each of consecutive HIV infected and uninfected) were enrolled during June 2012-May 2013 at School Of Tropical Medicine, Kolkata. Detailed medical history, physical examination and routine laboratory investigations besides FNAC and biopsy of lymph nodes were undertaken. Results: Males more affected in each group (1.2:1 in non HIV and 7.3:1 in HIV). Cervical nodes were most commonly(76% and 80% respectively) affected. Final diagnosis was TB (14 and 28), granulomatous other than TB (4 in each group), lymphoma(20-16 NHL, 4 Hodgkin's Lymphoma (HL) and 10-8 NHL and 2 HL), suppurative(6-bacterial and 4-all TB),metastatic carcinoma(2 and 4), reactive hyperplasia(4 and 0).Splenomegaly present in overall 40% patients. TB commonest cause (66.67%; 4 in each group) of peripheral lymphadenopathy with splenomegaly. Lymphoma commonest aetiology (57.14%; 14 in non HIV and 2 in HIV group) of peripheral lymphadenopathy with hepatosplenomegaly. In non HIV group, out of 18 reactive hyperplasia on FNAC 10 had TB, 4 had lymphoma and 4 remained reactive after biopsy. In HIV group, out of 18 reactive hyperplasia, 12 had TB, 4 lymphoma and 2 had granulomatous lymphadenitis other than TB. .Of 4 HIV patients with granulomatous lymphadenitis other than tuberculosis 2 each had cryptococcosis and histoplasmosis.In HIV group with TB, AFB was found in 55.56% in CD4 range 1-100; 25% in CD4: 101-200 and none in CD4:201-300.In HIV group 77.78% of patients with retroperitoneal lymphadenopathy had TB peripheral lymphadenitis. Picture 1. Cryptococcus in FNAC of lymph node of a HIV infected person Picture 2. Histoplasma in lymph node biopsy of a HIV infected person Conclusion: Cervical lymph nodes most commonly involved. Overall, non-malignant lesions were 64%, TB lymphadenitis being the commonest (42%) cause. Presence of hepatosplenomegaly may give clue to diagnosis.Chance of getting AFB in FNAC is more in HIV infected persons with lower CD4 count.Positive result with FNAC is highly reliable whereas a negative result is less.