Abstract

Background: Tuberculous lymphadenopathy is an important form of extrapulmonary tuberculosis. The role of fine needle aspiration cytology (FNAC) in the diagnosis of such lesions is a well-known fact.

Objective: To study the incidence, utility, limitations of FNAC, and various cytomorphological presentations in reference to Ziehl–Neelsen staining in tuberculous lymphadenitis.

Materials and Methods: A total 496 patients presenting with palpable cervical lymphadenopathies were referred to the cytology section of Pathology Department, Government Medical College, New Civil Hospital, Surat, Gujarat, India, over a period of 1 year (January to December 2014) were included in the study. The data entry was carried out using Microsoft Office Excel worksheet and analyzed.

Result: Of the 496 lymph node aspirations, 277 (45.8%) cases were diagnosed as tuberculous lymphadenitis. The age of the patient ranged from 5 months to 65 years. The maximum number of cases 167 (73.6%) suggestive of the cytomorphology of tuberculous lymphadenitis were aged in the range of 11–30 years. There were 113 (49.7%) female and 114 (50.3%) male subjects. Male subjects showed a slight predominance for tuberculosis. In this study, the most common site of the involved lymph nodes was of the cervical region in 91.2% (227/249) cases. The caseating epithelioid granulomatous pattern of tubercular lymphadenitis was the most common cytomorphological pattern seen in 47.6% of patients in this study. Acid-fast bacilli (AFB) positivity was the maximum in necrotizing and suppurative lymphadenitis (44.7%). The highest AFB positivity for tubercle bacilli was found in the aspirates, which were purulent in gross appearance (42.8%).

Conclusion: FNAC being a reliable, safe, rapid, and economical procedure is useful as an outdoor diagnostic procedure for the diagnosis of tubeculous lymphadenitis. From the cytomorphologic pattern and the AFB positivity, a rough estimate about the immune status can be made.

Key words: Tuberculous lymphadenitis, cytomorphological pattern, ZN stain for AFB, tubercle bacilli