Cytomorphological Spectrums in Tuberculous Lymphadenitis: Understanding the Stages of Disease

Abstract

Introduction: Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis and one of the main causes of lymphadenopathy. Fine Needle Aspiration Cytology (FNAC) has played a substantial role in diagnosis of tuberculous lymphadenopathy and it has become a first-line diagnostic technique. The aim of this study was to describe and understand the spectrum of cytomorphological changes seen in tuberculous lymphadenitis corresponding to stages of disease and to associate the cytomorphological changes with Acid Fast Bacilli (AFB) positivity.Methods: This is a retrospective cytomorphological study of cytologically diagnosed tuberculous lymphadenitis. The recorded details of clinical presentation and site of the lymph nodes were noted. The slides were stained with Papanicolaou, Giemsa and AFB.Result: There were a total of 203 cases with age ranging from 3-75 years. Four cytomorphological patterns observed were Necrotising Granulomatous Lymphadenitis (NGL; 45.32%), Granulomatous Lymphadenitis (GL, 18.22%), Necrotising Suppurative Lymphadenitis (NSL; 21.18%) and Necrotising Lymphadenitis (NL; 15.27%). Necrotising patterns were observed in immunocompromised individuals like HIV infected patients, in patients with previous history of tuberculosis and in patients with chronic renal disease. Strong AFB positivity was observed in necrotising patterns. Lymph nodes of head and neck region were the most common site of involvement with cervical being the commonest. Conclusion:Necrotizing patterns are observed in the later stages of disease or in the immunocompromised patients. Strong positivity for AFB is observed in the smears with necrotizing patterns and less in the granulomatous pattern.

A cytological study on peripheral lymphadenopathy in a tertiary care center with special reference to tuberculous lymphadenitis

“…In our study, the most common pattern seen on microscopy was pattern I showing epithelioid granuloma with necrosis in 53.5% (31/58) cases. Similar results were observed in studies Vashisht et al, 9 with 63.6% cases, Bhatta et al, 1 with 53.17% cases, Naz and Sharma 13 with 58.1% cases, Chaurasia and Sharma 5 with 60% cases, Jamsheed et al, 15 with 33.7% cases, and Pradhan et al, 16 with 45.32% cases in pattern I (Table 3). Hence, the most common pattern of tuberculous lymphadenitis seen on microscopy in comparison with different authors was pattern I showing epithelioid granuloma with necrosis.…”

Pretracheal tuberculous lymph node: an uncommon differential of a midline neck swelling

“…It is a simple and cost-effective investigative tool. Cytological criteria include the presence of lymphocytes, epithelioid cells, Langhans giant cells, neutrophils, caseous necrotic background (eosinophilic granular material without recognisable cellular elements), and haemorrhage,8 10 as was also reported in our case 11…”

Non-neoplastic Lesions among Lateral Neck Mass Specimens in a Tertiary Care Center: A Descriptive Cross-sectional Study

“…7 Hence, FNA smears with ZN stain is the first line diagnostic technique. 8 With the prompt diagnosis and treatment of tuberculosis morbidity and mortality can be reduced. 9 Thyroid lesions are the commonly encountered lesion in the world and FNAC is a safe and cost-effective diagnostic modality in screening thyroid masses.…”