Cytomorphological patterns of tubercular lymphadenitis revisited

Abstract

Background:Tubercular lymphadenitis is one of the most common causes of lymph node enlargement in developing countries. Fine needle aspiration cytology (FNAC) plays an important role in diagnosing Tubercular lymphadenitis and prevents unnecessary surgical intervention.Aim:To study the cytomorphological patterns of tubercular lymphadenitis in our study population and correlate the bacillary load by acid fast staining with cytomorphological patterns.Materials and Methods:A total of 150 cases of cytological proven granulomatous lymphadenitis and cases without granuloma, but positive acid fast bacilli (AFB) on Ziehl Neelson (ZN) stain were included in our study. Cytomorphological patterns were categorized into four patterns. Pattern A – Epithelioid granuloma without necrosis, Pattern B – Epithelioid granuloma with necrosis, Pattern C – Necrosis without epithelioid granuloma with neutrophilic infiltrate. Pattern D – with numerous macrophages. Chi-square test was done to correlate cytomorphological pattern and bacillary load. A 2 × 2 analysis was done to test the degree of one hypothesis. A P < 0.05 was considered as significant.Results:Patterns and the number of cases observed are as follows: Pattern A – 29 cases, Pattern B – 84 cases, Pattern C – 34 cases. A distinct D Pattern with abundant foamy macrophages was seen in three immunodeficient patients. Positive ZN staining was seen in 81/150 54% of cases. The cytological patterns of AFB positive cases Pattern A: 6/29 (21%), Pattern B: 46/84 (55%), Pattern C: 25/34 (73.5%), Pattern D: 4/4 (100%).Conclusion:FNAC is useful in diagnosing tubercular lymphadenitis. Maximum bacillary load was seen in Pattern C. A distinct D Pattern was seen in immunodeficient patients.

Utility of fine‐needle aspiration cytology in the diagnosis of HIV lymphadenopathy

“…Patterns I, III, and IV are diagnostic of tuberculosis. Pattern II, though not diagnostic (9.1% of cases in the present study), is highly indicative of tuberculosis until proved otherwise . Pattern II can be seen in HIV patients secondary to opportunistic fungal infections.…”

“…Pattern II, though not diagnostic (9.1% of cases in the present study), is highly indicative of tuberculosis until proved otherwise. 13 Cytologists should evaluate these cases for the presence of any AFB to rule out mycobacterial infection. 7 In HIV patients, the increased number of suppurative process can be attributed to decreased immunity and increased infection risk.…”

Granulomatous Inflammation: A Comparative Study Using Special Stains on FNAC Smears

“…A recent study conducted in our country shows an overall 54% AFB positivity [36] , Some studies report higher frequency of AFB positivity than ours like Bezabih et al reported 59.4% of overall AFB positivity [13] , and Vignesh et al reported 53.3% sensitivity for single AFB smear [29] .…”

Necrotizing Neck Mass in a Young Female

“…As illustrated by our patient, the most common factors associated with EPTB that have been reported in the literature are: Young age, female gender, Asian and African origin, and human immunodeficiency virus (HIV) infection, been this last one factor the most important when developing EPTB, but negative in our patient [3,4]. Interestingly from this case, our patient received treatment for LTBI, and still got infected by EPTB being an immunocompetent patient.…”

“…Interestingly from this case, our patient received treatment for LTBI, and still got infected by EPTB being an immunocompetent patient. There have been different studies that talk about the effectiveness of latent treatment and recurrence of the disease, reaching over 60% of protectiveness in HIV patients with CD4 cell counts above 200 cells/mm 3 , and for the other 40% of this study population who had progression from latent to active tuberculosis who had low CD4 cell count, high quantity of alcohol consumption, large size of TST induration or high viral load [5].…”