Abstract
Tubercular lymphadenitis is one of the most common extrapulmonary tubercular lesions presented in the Outpatient Department which is commonly diagnosed by Fine needle aspiration cytology. Cytological diagnosis of tuberculosis requires the presence of epithelioid cell granulomas demonstration with or without Langhan’s giant cells and necrosis. Sometimes, there can a proliferation of signet like cells without granulomas, which in a cervical lymph node can be given a false interpretation of metastatic signet cell carcinoma.
 A 35 year female patient with a complaint of cervical lymphadenopathy came to the medical OPD. FNAC was done which showed numerous scattered signet ring cells. However, epithelioid cell granulomas weren’t observed in the smears. Zeihl Neelsen stain for Acid fast bacilli was done but the organism wasn’t appreciated. A biopsy was done and a histopathological slide showed epithelioid cell granulomas and Langhan’s giant cell. Zeihl Neelsen Stain for Acid fast bacilli, which was positive.
Highlights
Tubercular lymphadenitis is one of the most common extra pulmonary tubercular lesion presented in the Outpatient Department[1] which is commonly diagnosed by Fine needle aspiration cytology, as it is comparatively safe and cheap procedure, requiring minimal instrumentation.[2]
There can a proliferation of signet like cells without granulomas, which in a cervical lymph node can be give a false interpretation of metastatic signet cell carcinoma
Histopathology is a gold standard for a diagnosis of lymph node pathology[4] which should always be done before reaching a diagnosis, whenever there is a diagnostic dilemma and a clinical mismatch
Summary
Tubercular lymphadenitis is one of the most common extra pulmonary tubercular lesion presented in the Outpatient Department[1] which is commonly diagnosed by Fine needle aspiration cytology, as it is comparatively safe and cheap procedure, requiring minimal instrumentation.[2]. There can a proliferation of signet like cells without granulomas, which in a cervical lymph node can be give a false interpretation of metastatic signet cell carcinoma. A 35 years female patient came to the Outpatient Department of Internal Medicine of Nobel Medical College, with a complaint of weight loss and enlarged cervical lymph node. Stain for Acid fast bacilli was done, but organism couldn’t be demonstrated. Numerous well formed epithelioid cell granulomas were seen (Fig.[2]). Zeihl Neelsen stain for Acid fast bacilli was done and organism was demonstrated (Fig.[3])
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