Cytomorphological spectrum of Extra Pulmonary Tuberculosis in Rural Tertiary Care Hospital: A Study

Abstract

This is estimated that about 1/3 rd of world population is infected with mycobacterium tuberculosis & most of the cases in Asia (55%) and Africa (31%) rest in others. Extra Pulmonary Tuberculosis (EPTB) reversed the epidemiological trend over the last several years. EPTB was has been increasing in absolute numbers and in proportions of all reported TB cases. Since very less data is available on EPTB and its distribution especially from this part of India therefore this study has been planned to assess the pattern of EPTB & the role of Fine Needle Aspiration Cytology (FNAC) in diagnosing these cases. This is a retrospective analysis of patients with peripheral lymphadenopathy & swelling on various sites. All the patients had fine needle aspiration. Smears were made, fixed in 95% alcohol and stained with giemsa, hematoxylin and eosin and Zeihl Neelsen (ZN) stains. The study includes 271 cases of extrapulmonary tuberculosis in which patient age range from one year to more than 51 years. Maximum no. of cases falls in the age group between 11 to 20 years. The mean age was 22.6 years. Females (63%) had higher proportion of EPTB than males (37%). Aspirates were mainly from cervical lymph nodes. Other sites were chest wall, breast, thigh, back etc. Macroscopically, 106 (39%) of the aspirates were purulent and 165 (61%) had necrotic material. Microscopy we divide it in three patterns, Pattern A (Epithelioid granuloma without necrosis) (39.11%); Pattern B (Epithelioid granuloma with necrosis) (45.75%); Pattern C (necrosis/neutrophilic aspirate) (15.12%). Staining for acid-fast bacilli was positive in 47 (17.34%) cases. Early diagnosis of extrapulmonary tuberculosis in a resource-limited setting can be achieved with fine needle aspiration cytology technique (FNAC). This will ensure prompt treatment and thus reduce attendant morbidity and mortality.