Cytopathological patterns of tuberculous lymphadenitis: an analysis of 126 cases in a tertiary care hospital
Keywords:Acid fast bacilli, Cytopathological patterns, Tuberculous lymphadenitis
Background: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy in developing countries. Fine needle aspiration cytology (FNAC) has important role in the diagnosis of tuberculous lymphadenitis. The objective of this study was to evaluate the cytopathological patterns of tuberculous lymphadenitis and to correlate with Ziehl-Neelsen (ZN) staining.
Methods: FNAC of 126 cases diagnosed as tuberculous lymphadenitis over a period of three years were reviewed. FNAC findings were categorized into three patterns: pattern A- epithelioid granuloma without caseous necrosis, pattern B- epithelioid granuloma with caseous necrosis, pattern C- caseous necrosis without epithelioid granuloma. Chi-square test was done to correlate cytopathological pattern and acid fast bacilli (AFB) positivity.
Results: Tuberculous lymphadenitis was most frequent in the age group of 21-30 years (40.5%). Most common lymph node involved was cervical lymph node (82.53%). The most common pattern observed was Pattern B- Epithelioid granuloma with caseous necrosis in 53.17% cases. Overall AFB positivity was seen in 34.92% cases. Maximum AFB positivity was seen in Pattern C- Caseous necrosis without epithelioid granuloma in 81.81% cases. Serum adenosine deaminase (ADA) was elevated in 66.66% patients.
Conclusions: FNAC is safe and cost effective diagnostic tool for the diagnosis of tuberculous lymphadenitis. Ziehl-Neelsen stain for Acid fast bacilli and Serum ADA can be used as an adjunctive tool for the diagnosis of tuberculous lymphadenitis.
Khajuria R, Goswami KC, Singh K, Dubey VK. Pattern of lymphadenopathy on fine needle aspiration cytology in Jammu. JK Science. 2006;8(3):157-9.
Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163:1009-21.
Ergete W, Bekele A. Acid fast bacilli in aspiration smears from tuberculous patients. Ethiop J Health Dev. 2000;14(1):99-104.
Giri S, Singh K. Fine needle aspiration cytology for the diagnosis of tuberculous lymphadenitis. IJCRR. 2012;4(24):124-30.
Das DK, Pant JN, Chachra KL, Murthy NS, Satyanarayan L, Thankamma TC, et al. Tuberculous lymphadenitis: correlation of cellular components and necrosis in lymph-node aspirate with AFB positivity and bacillary count. Ind J Pathology Microbiol. 1990 Jan;33(1):1-0.
Laishram RS, Devi RKB, Konjengbam, Devi RKT, Sharma LDC. Aspiration cytology for the diagnosis of tuberculous lymphadenopathies: A five year study. JIACM. 2010;11(1):31-5.
Nayak S, Puranik SC, Deshmukh SD, Mani R, Bhore AV, Bollinger RC. Fine‐needle aspiration cytology in tuberculous lymphadenitis of patients with and without HIV infection. Diagnostic cytopathology. 2004 Oct 1;31(4):204-6.
Sarwar A, Haque AU, Aftab S, Mustafa M, Moatasim A, Siddique S, et al. Spectrum of morphological changes in tuberculous lymphadenitis. Int J pathol. 2004;2(2):85-9.
Gupta AK, Nayar M, Chandra M. Reliability and limitations of fine needle aspiration cytology of lymphadenopathies; An analysis of 1261 cases. Acta Cytol. 1991;35:777-83.
Hemalatha A, Shruti P, Kumar MU, Bhaskaran A. Cytomorphological patterns of tubercular lymphadenitis revisited. Ann Med Health Sci Res. 2014 May;4(3):393-6.
Paliwal N, Thakur S, Mullick S, Gupta K. FNAC in tuberculous lymphadenitis: Experience from a tertiary level referral centre. Indian J Tuber. 2011;58:102-07.
Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis- a hospital-based study from central India. Inter J Infectious Diseases. 2009 Sep;13(5):600-05.
Bezabih M, Mariam DW, Selassie SG. Fine needle aspiration cytology of suspected tuberculous lymphadenitis. Cytopathology. 2002;13(5):284-90.
Khanna A, Khanna M, Manjari M. Cytomorphological patterns in the diagnosis of tuberculous lymphadenitis. Int J Med and Dent Sci. 2013;2(2):182-8.
Bhattacharya S, Raghuveer CV, Adhikari P. FNAC diagnosis of tuberculosis- an eight years study at Mangalore. Ind J Med SC. 1998;52:498-506.
Prasoon D. Acid fast bacilli in fine needle aspiration smears from tuberculous lymph nodes. Where to look for them. Acta Cytol. 2000;44:297-300.
Bhardwaj K, Bhardwaj BL, Goyal T. Fine needle aspiration cytology in lymph node disorders with special reference to tuberculosis. J Cytol. 2000;17:155-9.
Shahabuddin MD, Raghuveer CV. Role of fine needle aspiration cytology in detecting extrapulmonary tuberculosis. J Cytol. 2003;20:77-8.
Kumar N, Jain S, Murthy NS. Utility of fine needle aspiration in acute suppurative lesions. Follow-up of 263 cases. Acta Cytol. 2004;48(3):337-40.
Aljafari AS, Khalil EA, Elsiddig KE, El Hag IA, Ibrahim ME, Elsafi ME, et al. Diagnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR: a comparative study. Cytopathology. 2004 Feb 1;15(1):44-8.
Afrasiabian S, Mohsenpour B, Bagheri KH, Sigari N, Aftabi K. Diagnostic value of serum adenosine deaminase level in pulmonary tuberculosis. J Res Med Sci. 2013;18(3):252-4.
Cimen F. The relationship between serum adenosine deaminase levels in lung tuberculosis along with drug resistance and the category of tuberculosis. Turk Res J. 2008;9(1):20-3.
Mugulkod P, Chavan S. Serum adenosine deaminase levels and other laboratory parameters in the diagnosis of extrapulmonary tuberculosis: a clinicopathological study. Inter J Res Med Sci. 2017 Jun 24;5(7):3140-8.