FNAC of Lymph Node - A Valuable Clue to Diagnosis of Toxoplasma Lymphadenitis

Abstract

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107

Cyto-serological correlation in toxoplasma lymphadenitis: Is bypassing biopsy plausible?

“…To the best of authors' knowledge, this is 5th case series of cytodiagnosis of TL in the English literature and 2nd in the Indian literature. This is the largest case series of cytodiagnosis of TL in the Indian literature and 2nd largest in the world literaturenext to the one done by Haque et al 7 FNAC has become an integral part of the initial diagnosis and management of patients with lymphadenopathy. 18 It is important to diagnose the disease or provide clue to diagnosis in FNAC because it can avoid unnecessary surgery 11 and disease can be totally cured by medical management.…”

“…To the best of authors' knowledge, this is 5th case series of cytodiagnosis of TL in the English literature and 2nd in the Indian literature. This is the largest case series of cytodiagnosis of TL in the Indian literature and 2nd largest in the world literaturenext to the one done by Haque et al 7…”

“…Several reports describe cytological features of TL. 3,5,7,16 In some of them the authors highlight the presence of micro granulomas as the main cytological feature. These micro granulomas are very similar to the one we describe.(Fig.…”