Cause Of Lymphadenopathy Research Articles

A Study to Correlate between FNAC and Histopathological Diagnosis of Enlarged Lymph Node

Background: Aspiration of enlarged lymph node is commonly done. Although open biopsy with histopathological examination of tissue still remains the gold standard yet F.N.A.C. is an integral part of initial diagnosis. Objective: To highlight the role of F.N.A.C. in the diagnosis of etiological profile of lymphadenopathy and to find out the accuracy of F.N.A.C. in comparison to histopathological diagnosis. Methods: The prospective study was done for two years. The results of lymph node F.N.A.C. were compared and evaluated taking histopathology as gold standard. Results: Cervical lymph node were most commonly involved. Most common cause of lymphadenopathy in children was reactive hyperplasia and tuberculosis in adults.Conclusion: The sensitivity and diagnostic accuracy of F.N.A.C. results were high when compared with histopathological findings.

Kimura's disease - an unusual case of neck swelling

Abstract Background: Kimura's disease is an uncommon cause of lymphadenopathy in pediatric age group. Case characteristics: Usually presents as a triad of lymphadenopathy, hyper eosinophilia and hyper IgG. Kimura's presenting as a neck swelling is rare. Intervention: Excised mass was sent for histopathology. Message: To reduce concerns of malignancy.

Fine Needle Aspiration Cytology in Cervical Lymphadenopathy; A Key to Divergent Locks.

Cervical lymphadenopathy is ranked among the most common clinical findings encountered in patients with multiple diseases ranging from benign to malignant lesions. Fine needle aspiration cytology (FNAC) is an effective tool for the assessment and diagnosis of superficial cervical lymph node enlargement. The aim of our study is to see the spectrum of lesions causing cervical lymphadenopathy in our region and the role of FNAC in its definite and early diagnosis. In these 6 years data of a total number of 1338 patients with cervical lymphadenopathy which were referred from the outpatient clinics for cytological examination were retrieved. FNAC was performed using 23 gauge needle attached to 20ml syringe. Aspirated materials were smeared into 2-3 slides which were stained with May Grunwald Giemsa (MGG) stain and using Dibutyl Phathalate Xylene (D.P.X) mountant, were prepared for cytological examination. Six year data was collected and compiled into various categories. Tubercular lymphadenitis (53.8%) was the commonest cause of lymphadenopathy followed by reactive lymphoid hyperplasia (27.8%), metastasis (14.6%) and lymphomas (3.6%). Squamous cell carcinoma (10.7%) followed by adenocarcinoma (3.9%) were the most frequent metastatic tumors. FNAC is a useful diagnostic tool and a valuable revolution in the management of patients presenting with cervical lymphadenopathy and should be considered before more invasive and costly procedures are performed, particularly in developing countries with resource poor settings.

An insight on pediatric peripheral Lymphadenopathy: Atwo year cytological study in a tertiary care hospital

Introduction & Objective: Lymphadenopathy in pediatric population is an ever challenging situation. This study was done to study the cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by fine needle aspiration cytology (FNAC) and determine the pattern of diseases affecting the children below 18 years.Materials and Methods: 453 cases between the age group of 0-18 years, referred to the cytology section of the department of Pathology were included in the study over a period of two years. Special stains and biopsy were done in selected cases. Results: Majority of the cases were benign (97.60%), while only 2.4% (13/543 cases) of cases were malignant. Reactive hyperplasia, tuberculous lymphadenitis, suppurative lymphadenitis, metastatic carcinoma and lymphoma were seen in 53.2%, 30.20%, 10.68%, 0.2% and 1.8% respectively. Cervical group of lymph nodes were the most frequently affected nodes. In 37 cases, the cytological diagnosis was compared with histopathological diagnosis.Conclusion: The most frequent cause for lymphadenopathy in pediatric population is reactive hyperplasia followed by tuberculosis.FNAC alone can be useful in establishing diagnosis in large number of cases in proper clinical setting and obviates the need for invasive procedures like surgery. Introduction & Objective: Lymphadenopathy in pediatric population is an ever challenging situation. This study was done to study the cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by fine needle aspiration cytology (FNAC) and determine the pattern of diseases affecting the children below 18 years. Materials and Methods: 453 cases between the age group of 0-18 years, referred to the cytology section of the department of Pathology were included in the study over a period of two years. Special stains and biopsy were done in selected cases. Results: Majority of the cases were benign (97.60%), while only 2.4% (13/543 cases) of cases were malignant. Reactive hyperplasia, tuberculous lymphadenitis, suppurative lymphadenitis, metastatic carcinoma and lymphoma were seen in 53.2%, 30.20%, 10.68%, 0.2% and 1.8% respectively. Cervical group of lymph nodes were the most frequently affected nodes. In 37 cases, the cytological diagnosis was compared with histopathological diagnosis. Conclusion: The most frequent cause for lymphadenopathy in pediatric population is reactive hyperplasia followed by tuberculosis.FNAC alone can be useful in establishing diagnosis in large number of cases in proper clinical setting and obviates the need for invasive procedures like surgery. Normal 0 false false false EN-IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Value of ultrasound in evaluation of cervical lymphadenopathy: correlation with FNAC / histopathology

Introduction: The role of high-resolution ultrasound in evaluation of cervical lymph nodes is well established. The aim of this study was to determine its accuracy in differentiating benign and malignant cervical lymphadenopathy. The objectives were to study various sonographic features applicable in routine clinical practice to identify and differentiate various types of cervical lymphadenopathy.
 Methods: The study was done at the Pathology and Radiology department of Manipal teaching hospital (MTH) from Jan 2015 to Dec 2015. Seventy cervical nodes in 70 patients (17-reactive, 23-tuberculous, 9-lymphoma and 21-metastatic) were evaluated by high resolution ultrasound (7.5- 10MHz). Shape (S:L ratio), (maximal short to maximal long axis ratio diameter) nodal margins, hilar echogenicity, vascular pattern, distribution, size, echogenicity, calcification, posterior enhancement, eccentric cortical hypertrophy, matting and soft tissue edema were assessed. Confirmed diagnosis was either made by USG guided FNAC on the largest node or by open biopsy. The first four parameters had the most significant differences between benign and malignant lymph nodes and were evaluated to calculate the accuracy of ultrasound in their differentiation. Individual groups were compared and optimal sonographic features in differential diagnosis were determined.
 Results: The common useful sonographic features to identify different types of cervical lymph nodes were S:L ratio, nodal margins, hilar echogenicity, vascular pattern, matting, soft tissue edema, echogeneity, intranodal necrosis, displaced hilar vascularity, eccentric cortical hypertrophy and posterior enhancement. Vascularity was the most accurate parameter (86%) when used in isolation and when combined parameters were used ultrasound had accuracy of 97% in diagnosing benign or malignant cervical lymphadenopathy.
 Conclusion: This study showed that high resolution ultrasound has a high degree of accuracy in differentiating benign and malignant cervical lymphadenopathy and assists in differentiating various causes of lymphadenopathy.

P233 A Case of CMV (Cancer Mimicking Virulence)

Background/introduction Generalised lymphadenopathy and fatigue have a broad differential diagnosis ranging from curable infections to lymphoma. Certain diagnoses can be delayed or missed altogether when patients do not present to sexual health clinics. Aim(s)/objectives Highlight secondary syphilis as a cause of lymphadenopathy amongst non-sexual health colleagues. Expand syphilis testing beyond sexual health clinics, even in the absence of classical risk factors. Methods Case report of secondary syphilis which was misdiagnosed despite numerous investigations in primary and secondary care. Results A 23 year Caucasian lady was referred to lymphoma clinic by her GP with a three month history of lymphadenopathy and fatigue. She was diagnosed with a primary CMV infection and lost to follow up after her symptoms resolved. One year later she attempted to donate blood. Positive syphilis serology with a low RPR was detected on routine blood screening by the transfusion service. The patient was referred to Bristol Sexual Health Centre where sexual history taking revealed she had a bi sexual partner at the time of her illness who also tested positive for syphilis. An archived blood sample from the time of her illness revealed active syphilis infection with a high RPR. Discussion/conclusion Secondary syphilis can mimic numerous illnesses. However syphilis testing remains uncommon outside of sexual health clinics for a variety of reasons. A change of culture is required to ensure medical professionals are prepared for routine sexual enquiry and consider syphilis as a potential cause for lymphadenopathy.

Evaluation of pathologic lesions in superficial lymph node biopsies

Introduction: Lymphadenopathy can be due to any disease process involving lymph nodes. Enlargement of lymph node is a very common clinical symptom seen in outpatient department of any hospital. Lymphadenopathy can occur at any age group and at any site of the body. Detail clinical history for signs and symptoms, size of lymph nodes, presence of generalized lymphadenopathy, and hepatosplenomegaly help to arrive at provisional diagnosis. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping of lymphomas. Aim: The aim of present study is to analyze pathological spectrum of various neoplastic and non-neoplastic lesions affecting superficial lymph nodes in the neck, axilla, inguinal region and correlation with clinical findings. Materials and Methods: The present study was a retrospective study conducted in the department of Pathology, at Chalmeda Anand Rao Institute of Medical Sciences, Bommakal Karimnagar,during the period from february 2014 to march 2015. Lymph node biopsies of all patients of both sexes and all age groups were included. Total 47 lymph node biopsies were selected for histopathological evaluation which constituted the study material. Among these 25 were from males and 22 were from females with male to female ratio being 1.2:1. The age of the patients ranged from 3 to 71 years with a mean age of 40-49 years. Results: Out of total 47 cases, 15(31.9%) cases were tuberculous lymphadenitis ,13 cases (27.6%) were malignant lymphoma while metastasis was found in 10(21.2%) cases, reactive hyperplasia in 5(10.6%) cases, suppurative lymphadenitis in 2(4.2%) cases, castleman disease and kikuchi disease, the least common condition was seen in only one case(2.1%) each. Cervical lymph nodes were most commonly biopsied group of lymph nodes in our study. Conclusion: Tuberculosis was the most common cause of lymphadenopathy, followed by malignant lymphoma and the cervical group of lymph nodes was most frequently affected.

Características clínicas e histológicas de adenopatías en pacientes pediátricos

BackgroundLymphadenopathy is a common cause for medical consultation in the child population, accounting for up to 44% in children under 5 years old. In some cases, it is required to take lymph node biopsy specimens in order to clarify the diagnosis. ObjectiveTo describe the clinical and histological features of paediatric patients with lymphadenopathy and lymph node biopsies. Patients and methodDescriptive and retrospective study conducted in Medellin (Colombia) in a fourth-level hospital between January 1st of 2009 and December 31st of 2012. In the study, lymph node biopsy specimens were taken from children under 15 years old. Demographic, clinical and laboratory features, and characteristics of the patients were evaluated, as well as the histopathological diagnosis of the lymph node biopsies. ResultsFrom the child population, 61 children met the eligibility criteria and 33 (54.1%) of them were male with an average age of 6 years old. The most common pathological diagnoses in the study group were as follows: reactive hyperplasia (50.8%), neoplasms (27.9%), chronic granulomatous disease (4.9%), and bacterial infection (3.3%). It could be concluded from the findings in the study that Hodgkin lymphoma is very common among the neoplastic diseases, with 18%, and the most frequent location was the neck with 60.6%. ConclusionsThis study demonstrates the importance of performing a differential diagnosis when approaching patients with lymphadenopathy. As reported in the world medical literature, benign origin is the most common cause of lymphadenopathy in children.

Ten-year review of peripheral lymphadenopathy in tertiary Hospital in South Western Nigeria

INTRODUCTION: peripheral lymphadenopathy is a common clinical presentation in Nigeria, and there have been many studies published on it from different parts of the country. This study is to provide an update on the clinicopathological pattern of lymphadenopathy in Ibadan. METHODS: lymph node biopsies received at the Department of Pathology, University College Hospital, Ibadan, Nigeria from January st 2003 to December 31st 2012 were reviewed. Special stains and immunohistochemistry were also applied. RESULTS: 429 cases,251 females and 178 in males were studied. Modal age group was in the sixth decade. The mean age of females (41.4 years) was significantly greater than that of males (34.5 years), p=0.000. Commonest sites were axillary (31.5%) and neck groups (24%), with axillary nodes more often involved in females and neck group of nodes more often involved in males. Metastatic cancer and reactive hyperplasia were the commonest diseases. Males more frequently had non-specific hyperplasia (34.3%) and non-Hodgkin lymphoma (23.6%), while females more often had metastasis (45.4%) and non-specific hyperplasia (19.1%). Patients with metastatic cancer had the highest mean age of 46.5 years, followed by those with malignant lymphomas and reactive hyperplasia. CONCLUSION: primary and metastatic malignancies are common causes of lymphadenopathy in this environment. The use of selective immunohistochemical antibody panels is advocated for proper diagnosis of malignant lesions of the lymph node.

Diagnostic accuracy of Fine needle aspiration cytology in lymphadenopathy-our experience in a tertiary care hospital

Aim and objective: To study the different causes of lymphadenopathy and to document the various causes of enlargement of lymph nodes. Materials and methods: 294 cases of lymphadenopathy patients were included in this study who visited the pathology department in our medical college hospital from January 2014 to September 2015. For each patient, minimum four smears were made from each site of aspiration and smears are stained with Papanicolaou stain routinely and special stains were used wherever necessary arose. Results and conclusion: Accuracy of diagnosis was more than 95% in most of the cases and 100% in metastatic diseases. Subtyping of Non Hodgkin lymphoma was not possible as histopathology and Immunohistochemistry are gold standards for these lymphomas. Key words: FNAC, lymph nodes, metastasis, Hodgkin lymphoma, granuloma.

Clinicocytomorphological spectrum of palpable Lymphadenopathies in Kumaon region of Uttarakhand

Background: To study the cytological patterns of lymphadenopathy in our setting to determine the demographic parameters and the clinical presentation of the various causes of lymphadenopathy in adults and children and the diagnostic utility of FNAC in the evaluation of lymphadenopathy. This would help the doctors attending patients in this region to have a basic idea about prevalence of different clinical profiles of palpable lymphadenopathy for easier case detection and better therapeutic outcome. Material & Methods: FNAC was performed using a 22 or 23 gauge needle attached to 20 ml disposable plastic syringe mounted on a syringe holder for single hand grip was used, Slides will be fixed in 95% ethyl alcohol for cytological evaluation using Papanicolaou staining (PAP) and Hematoxylin and Eosin (H&E) stain. Smears are kept air-dried for May–Grunwald–Giemsa staining and Ziehl Neelsen stain. Results: Out of 665 cases, 372 cases (55.9%) were males while 293 cases (44.1%) were females. Male to female ratio is 1.3: 1. Out of total, 76.1% cases were benign and 23.9% cases were malignant. Keywords: FNAC, Lymphadenopathy, Reactive, Granulomatous, Kumaon

Cytological Study of Cervical Lymphadenopathy in a Trtiary Care Institution from Kashmir Valley, India

Background: Cervical lymphadenopathy is a common clinical finding in all age-groups that ranges in etiology from inflammation to malignancy. Fine needle aspiration cytology (FNAC) is a standard first-line investigation in the evaluation of cervical lymphadenopathy. Objective: The study aimed to analyze the clinical profile and causes of cervical lymphadenopathy in different age-groups and the diagnostic utility of FNAC in our setup. Methods: This retrospective study included all the patients of cervical lymphadenopathy of more than 2-3 weeks duration, who underwent FNAC in our tertiary care institution in Kashmir valley, India during the two-year study period (January 2009-December 2011) in whom the aspirated material was adequate and satisfactory for evaluation. Results: A total of 790 patients were selected. Upper deep cervical lymph nodes were involved most frequently (38.9%); reactive lymphadenitis (39.4%) followed by metastasis (38.2%) were the commonest causes, in general. In addition, reactive lymphadenitis was the most common cause of lymphadenopathy in all age groups less than 40 years and at all topographic sites of cervical lymph node. However, in more than 40 years age-groups and at supraclavicular region, metastasis was the commonest cause of enlargement. Squamous cell carcinoma (36.4%) followed by adenocarcinoma, (25.8%) were the most common metastatic tumors. Conclusion: Enlargement of cervical lymph nodes, particularly in elderly patients involving supraclavicular nodes, should raise a suspicion of malignancy; and cervical lymphadenopathy can be effectively evaluated by FNAC without the need for surgical biopsy.

The validation of an algorithm for the management of paediatric cervical lymphadenopathy

Neck lumps are common in children, with cervical lymphadenopathy being the most frequent cause [1,2]. Infective or inflammatory lymphadenitis is attributed as a potential cause of lymphadenopathy through all stages of childhood [3]. The majority of enlarged nodes are reactive and malignancy is rare. When presented with a child with a neck lump the clinician must exclude malignancy but should not over investigate or perform unnecessary procedures. It was apparent at our unit that children with neck lumps were being seen at most of the ear, nose and throat clinics. The patients were being seen by different grades of doctor including consultant, registrar and more junior doctors with senior supervision. The management often varied between patients, and depending on who had seen them a variety of blood tests and investigations were performed. The patients frequently had multiple clinic attendances and the biopsy rate was thought to be high. It was also suggested that multiple clinic attendances may be adding to a delay prior to biopsies being performed. There was a clear need for a cohesive strategy for the management of these patients.

Castleman's Disease as a Rare Differential Diagnosis of Lymphadenopathy: 2 Case Reports and Review of Literature

ntroduction: Lymphadenopathy is a common complaint in children. It's defined as abnormality in size or character of lymph node. It may be localized or generalized. It may be part of a group of signs and symptoms or the sole finding and chief complaint. Several reasons can lead to Lymphadenopathy. Castleman's disease is a rare differential diagnosis of generalized or localized Lymphadenopathy. It's a rare lymph proliferative disorder that rarely occurs in children. Case presentation: We reported two cases, the first one was 13 years old female with multicenteric castleman's disease associated with constitutional manifestations and unusual hyaline vascular pathology successfully treated with monthly combination chemotherapy, the second one was 2.5 years old male with unicentric hyaline vascular castleman's disease with unusual young age at presentation successfully treated with surgical excision. Conclusion: Castleman's disease is a rare cause of Lymphadenopathy. Although, it's rare in children, it can occur at any age. Most of cases of multicenteric castleman's disease are plasma cell variant, yet hyaline vascular type may occur. Multicenteric castleman's disease can be successfully treated with monthly combination chemotherapy. Most cases of unicentric castleman's disease are hyaline vascular type. Although, surgical removal of unicentric type is usually sufficient to achieve complete remission, recurrence can still occur.

Patterns of lymphadenopathy on fine needle aspiration cytology in eastern Nepal

BACKGROUND: Lymphadenopathy is a commonly encountered clinical problem. Fine needle aspiration cytology offers the alternative of an immediate, preliminary, although not always specific diagnosis with little trauma and cost, thus providing ample information for further management and reduce the amount of open biopsy.MATERIAL AND METHODS: FNAC was performed using 21 gauge needle attached with 10ml disposable needle. Slides were prepared, two were air dried and stained with field stain where as two were fixed in ethanol and was stained with PAP stain. One slide was stained with Ziehl-Neelson stain. Field and PAP stained slide were reviewed and diagnosed by Pathologist.RESULT: Out of the 225 patients, reactive lymphadenitis was the most common diagnosis (54.2%), followed by tubercular lymphadenitis (33.44%). Among the age group percentage of tubercular lymphadenitis was more in 210-30 years of age. Majority of the metastatic carcinoma was in cervical region, comprising mainly squamous cell carcinoma.CONCLUSION: Reactive lymphadenitis was the most common cause of lymphadenopathy especially in case of children. In case of older population, definite pathology for lymph node enlargement was found in most of the cases. Hence FNAC is warranted in lymphadenopathy, as it is simple yet of great diagnostic value.

Lymphadenopathy : Histopathological evaluation of 90 Cases in Chittagong

Lymphadenopathy is one of the common clinical presentation of patients suffering from different disease processes. Lymphnode enlargement may be due to reactive changes, tuberculosis, sarcoidosis, Hodgkin lymphoma, Non Hodgkin lymphoma, Metastatic deposits etc. Histopathological examination of the enlarged lymphnode is the gold standard method to ascertain the cause of the enlargement. The objective of our study was to explore the causes of lymphadenopathy in the population of Chittagong. The study was conducted in the department of Pathology, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong during January 2012 to July 2014. A total of 90 (Ninety) lymphoid tissue specimens were received and Hematoxilin Eosin stained histopathological slides were prepared and microscopic examination was done. The most common morphologic changes of lymphadenopathy noted was reactive hyperplasia (36.66%) and other causes included were tuberculosis (27.77%), metastasis (20%), Non-Hodgkin lymphoma (7.77%), Hodgkin lymphoma (4.44%) and suppurative lymphadenitis (3.33%). Our observations are supported by some other national and international studies on lymphadenopathy.DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22874 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 19-21

Cat-scratch disease with bulky lymphadenopathy. A case report

Abstract Cat-scratch disease is an uncommon cause of lymphadenopathy in India. It occurs in children and presents as a regional lymphadenopathy. It is a benign, self-limiting disease caused by Bartonella henselae, a bacterium. Clinically, a wide spectrum of differential diagnosis such as tuberculosis, Epstein Barr virus infection, malignancies like lymphomas and metastases may be considered and should be ruled out before the treatment is decided. We report this case, as the patient presented with a very large sized lymph node, giving a clinical suspicion of lymphoma.

English

BACKGROUND: Lymphadenopathy is one of the commonest clinical presentation among the children (0-14years) having several etiologies and can pose a diagnostic dilemma to a pediatrician. FNAC is an important and rapid diagnostic modality for the etiologic workup in significant lymphadenopathy. AIMS AND OBJECTIVES: To know the incidence of various causes of lymphadenopathy in children. To know the advantages of FNAC over surgical biopsy. MATERIALS AND METHODS: The present study comprises of FNAC of lymph nodes of 120 cases in pediatric age between 0-14years with lymphadenopathy, who attended the OPD and those admitted in Khaja Banda Nawaz Teaching and General Hospital, Gulbarga during the period between JAN 2013 to DEC 2014. Detailed history and thorough clinical examination and routine examination was done on approach of the patient. FNAC was carried out in all cases on significant lymph nodes and aspirated materials was smeared and sent to laboratory various stains were used for staining cytological smears. RESULTS: Over all lymphadenopathy was common in (5-10years) age (35%), higher in males (54.1%) than females. Anatomically cervical lymphadenopathy was commonest (90%). Most common cause was found to be TB lymphadenitis. CONCLUSION: FNAC of lymph node in children is simple rapid diagnostic method with minimum discomfort to the patient and readily accepted by

English

BACKGROUND & OBJECTIVE: Lymph node biopsy is an important tool for diagnosis,staging & prognosis determination. This study was undertaken to determine the histo- pathological spectrum of lymphadenectomies at a tertiary care Centre at Rajasthan. METHODS: In a cross sectional observational study, 573 histologically diagnosed lymph node biopsies from January 2008 to December 2012 were reviewed. The patient's history, clinical features & definite pathologic findings were reviewed. RESULTS: 573 patients (Male 306, Females 267) maximum biopsies were cervical (53.5%), Axillary (22.8%). Overall biopsies revealed TB (63.3%), Chronic Non Specific Lymphadenitis (13.4%), Reactive Hyperplasia (6.4%) & Lymphoproliferative disorder (2%).76 patients were suspected to have Metastatic lesion clinically, but it was found in 29(5.06%) on histological evaluation. Tubercular lymphadenitis was the commonest diagnosis in all age groups. CNSL (20.6%) was commonest in 1-20 years, Metastatic (15.3%) in 61-80 years. CONCLUSION: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Tubercular lymphadenitis is the commonest finding in spectrum of diseases affecting lymph nodes from this region.

Correlation of cytomorphological patterns and acid-fast Bacilli positivity in tuberculous lymphadenitis in a rural population of southern India.

Background:One of the most common causes of lymphadenopathy in India is tuberculosis. It can be diagnosed by a minimally invasive procedure known as fine-needle aspiration cytology (FNAC), and thereby unnecessary surgical interventions are avoided.Aim:This study was undertaken to evaluate cytomorphological patterns of tuberculous lymphadenitis including human immunodeficiency virus-positive cases, to correlate the acid-fast Bacilli (AFB) positivity with cytomorphological patterns and also to find out overall AFB positivity.Materials and Methods:In this study, a total of 212 cases of cytologically proven tuberculous lymphadenitis were retrieved and analyzed retrospectively between March 2012 and March 2015 for three different cytomorphological patterns (epithelioid granuloma without necrosis [pattern A], epithelioid granuloma with necrosis [pattern B], and necrosis without epithelioid granuloma [pattern C]) and bacillary loads on Ziehl-Neelsen stain (ZN) for AFB.Results:Pattern A through C was observed in 40 (18.9%), 102 (48.1%), and 70 (33%) cases, respectively. AFB positivity was found in 2 (5%) cases of pattern A, 62 (60.8%) cases of pattern B, and 54 (77.1%) cases of pattern C. The highest percentage of AFB positivity (64.7%) was observed in aspirate containing purulent/pus and caseous/cheesy material. The overall AFB positivity was seen in 55.7% (118/212) cases. On grading of AFB positivity, Grade 1+ was observed in 29.7%, Grade 2+ was observed in 28.8%, and Grade 3+ was observed in 41.5% cases.Conclusion:FNAC is a sensitive, simple, convenient, safe, minimally invasive procedure to diagnose tuberculous lymphadenitis. Study of both cytomorphological patterns and ZN staining for AFB can improve the diagnostic yield. Regardless of the presence of granuloma, ZN stain must be employed whenever infective pathology is suspected.