Cytomorphology of lymphadenopathy with a report on patterns of tuberculous lymphadenitis in a resource-limited setting

Abstract

Context: Lymphadenopathy is one of most common clinical presentations, for which fine-needle aspiration (FNA) is indicated as the first-line investigation since it is a reliable, rapid, simple, cost-effective procedure done in the outpatient department. Aims: The study was performed to assess the various cytomorphological patterns of the lymph node aspirates in patients presenting with peripheral lymphadenopathy. Subjects and Methods: The prospective study included 81 patients with complaints of peripheral lymphadenopathy on whom FNA was done in the Department of Pathology at our hospital. The smears were analyzed and categorized according to their cytomorphological patterns. Results: Of 81 patients, 30 were male and 51 were female. The male:female ratio was 1:1.7. The age of the patients ranged from 3 to 83 years, with a mean age of 35.2 years. Reactive lymphadenitis (48.15%) was the most common lesion followed by tuberculous lymphadenitis (33.33%). Acid–fast bacilli (AFB) positivity was noted in 13 out of 27 cases (48.15%) with tuberculous lymphadenitis. The cases of tuberculous lymphadenitis were further divided into three groups based on cytomorphology, of which Group 2 lesions (epithelioid granulomas with necrosis) were most common and Group 1 lesions (epithelioid granulomas without necrosis) were least reported. Group 3 lesions (necrosis without epithelioid granulomas) were all positive for AFB. There were nine cases (11.11%) of acute suppurative lymphadenitis and six cases (7.41%) of metastatic squamous cell carcinoma to the lymph nodes. Conclusions: FNA is an ideal tool which can be used as a basic investigation for the evaluation of lymphadenopathy. Reactive lymphadenitis followed by tuberculosis was the major cause of lymph node enlargement in our setup. Epithelioid granulomas with or without necrosis and/or AFB positivity on the cytological smears and with associated clinical symptoms should be considered as tuberculosis in our clinical setup unless proven otherwise.

Keywords

• cytomorphological patterns
• fine-needle aspiration
• lymphadenopathy
• reactive lymphadenitis
• tuberculosis