An Insight on Cytomorphological Patterns of Tuberculous Lymphadenopathy in Paediatric Age Group

Abstract

Introduction: The incidence of Tuberculosis (TB) in a developing country like India is very high. Lymphadenopathy is the commonest extrapulmonary manifestation of the disease. In rural and remote areas of India where adequate infrastructure is not available, many cases remain undiagnosed for a long time. Fine Needle Aspiration Cytology (FNAC) may be used as an important diagnostic tool in these cases. Aim: To provide an insight in the cytomorphological patterns of tuberculous lymphadenopathy complemented with Acid Fast Bacilli (AFB) staining in patients of paediatric age group. Materials and Methods: It was an observational study involving 175 patients of 0-18 years of age, presenting with peripheral lymphadenopathy in the Out Patient Department/In Patient Department (OPD/IPD) of different departments of Silchar Medical College and Hospital, Silchar, Assam. The duration of the study was one and half years from June 2013 to December 2015. FNAC was done from the enlarged lymph nodes and smears were stained with Giemsa, Papanicolaou, and Ziehl- Neelsen (ZN) staining. Cytomorphological analysis was made for the cases diagnosed with tuberculous lymphadenopathy. Simple statistical analysis was done using Microsoft (MS) EXCEL 2013. Results: Out of 175 cases, 58 (33.14%) cases were diagnosed with tuberculous lymphadenopathy. Cervical lymph nodes were most commonly involved (42 cases, 72%), followed by axillary lymph nodes, and then generalised lymphadenopathy followed by inguinal lymph node involvement. Cytomorphological analysis showed 33 (56.89%) cases of epithelioid granulomas with caseous necrosis; 14 (24.14%) cases of epithelioid granulomas without caseous necrosis and 11 (18.97%) cases of caseous necrosis without epithelioid granulomas. Overall AFB positivity was 34.48%. Necrosis was found to be associated with highest AFB positivity (81.82%). Conclusion: The incidence of tuberculous lymphadenopathy in the current study was significantly high. In a resource poor setting, FNAC is useful in diagnosing tuberculous lymphadenopathy where cytomorphology can be complemented with AFB staining to improve diagnostic accuracy.