Gambaran Klinis dan Histopatologis Pasien Limfadenopati Granulomatosa yang Berobat di Rumah Sakit Muhammadiyah Bandung

Abstract

Limfadenopati granulomatosa memiliki beragam etiologi yang mendasarinya. Secara garis besar dapat diklasifikasikan karena infeksi dan non infeksi. Gambaran histopatologi limfadenitis granulomatosa membentuk struktur khusus seperti sel epiteloid disertai dengan sebukan sel radang, namun tidak spesifik. Limfadenitis tuberkulosis merupakan penyebab tersering limfadenopati di daerah endemis tuberkulosis seperti di Indonesia. Karakteristik klinis dan penunjang seperti pemeriksaan rontgen dapat membantu mendiagnosis penyakit yang mendasari lesi ini. Tujuan penelitian ini mengetahui gambaran klinis dan histopatologis limfadenitis granulomatosa di Rumah Sakit Muhammadiyah Bandung yang diharapkan dapat membantu mengarahkan diagnosis. Penelitian ini merupakan studi deskriptif kuantitatif yang diambil dari data rekam medis 40 pasien limfadenopati granulomatosa di Rumah Sakit Muhammadiyah Bandung periode Januari–Desember 2022. Hasil penelitian menunjukkan sebanyak 52% adalah perempuan, terbanyak di rentang usia 22–31 tahun (30%). Lesi terbanyak ditemukan di daerah leher kanan (35%) dengan gejala penyerta terbanyak adalah nyeri (20%). Hasil rontgen normal (23%) ditemukan lebih banyak dibanding dengan yang disertai kelainan. Karakteristik gambaran distribusi histopatologis paling banyak adalah sel radang limfosit (100%), histiosit (95%), dan sel epiteloid (92%), sedangkan paling sedikit adalah datia benda asing (20%). Limfadenitis tuberkulosis merupakan penyakit tersering yang mengakibatkan benjolan di leher dan menimbulkan gambaran histopatologi berupa granuloma yang beragam mulai dari granuloma bernekrosis, granuloma non nekrosis, dan granuloma supuratif. Pada penelitian ini didapatkan ketiga gambaran granuloma tersebut. Meskipun tempat penelitian ini di Indonesia merupakan endemi tuberkulosis, namun tetap perlu dipikirkan diagnosis banding lain yang harus disingkirkan sebelum menegakkan diagnosis yang tepat.AbstractGranulomatous limphadenopaty has various underlying etiologies. In general granulomatous lymphadenopathy can be classified as infectious and non-infectious. The histopathologic features of granulomatous lymphadenopathy creates a special structure with epitheloid cells surrounded by inflammatory cells, however these are not spesific. Tuberculous lymphadenitis is the frequent cause for lymphadenopathy in endemic area for tuberculosis as Indonesia. The clinical features and chest X-ray examination can be helpful for establishing the underlying diagnosis for the lesion. The aim of this research is to determine the clinical and histopathological features of granulomatous limphadenopaty at the Muhammadiyah Bandung Hospital for the period January–December 2022 which is expected to help in directing the diagnosis later. This study is a quantitative descriptional study from medical records of 40 patients with granulomatous lymphadenopathy admitted to Muhammadiyah Hospital in periode of January–December 2022. The results showed 52% patients were female, mostly in age group of 22–31 years old (30%). Most lesions located at right neck (35%), with pain as most frequent accompanied symptom (20%). Normal chest X-rays were more frequent than those with abnormal findings. The histopathologic features of the lesion showed the most histopathological distribution is lymphocyte inflammatory cells (100%), histiocytes (95%), and epithelioid cells (92%), while the least is foreign body datia (20%). Tuberculous lymphadenitis is the commonest etiology for diseases presenting with cervical adenopathy with histopatologic features of granuloma ranging from necrotizing, non necrotizing and suppurative granuloma. The three types of granulomas were found in this study. Despite that Indonesia the endemic area for tuberculosis, other differential diagnosis still needed to be eliminated before appropriate diagnosis can be made.