Cytomorphological patterns of tubercular lymphadenitis and its comparison with Ziehl-Neelsen staining and culture in eastern up. (Gorakhpur region): Cytological study of 400 cases

Shaila K Mitra, Rajiv K Misra, Priyanka Rai

Journal of Cytology 2017 34(3):139-143

Background: Tuberculous lymphadenitis is most common cause of lymphadenopathy in developing countries. Although enormous literature is available on various aspects of the disease including cytological patterns and its incidence in others parts of India and in other countries, only limited literature is available regarding its incidence and morphological spectrum on cytology in eastern parts of Uttar Pradesh in Gorakhpur region. Aim: The present study was undertaken to estimate the incidence of tuberculous lymphadenitis in our settings along with its morphological spectrum on cytology as well as to determine the utility of culture of fine needle aspirates in addition to cytology and Ziehl–Neelsen (ZN) staining. Material and Methods: Four hundred cases of superficial lymphadenopathy were subjected to fine needle aspiration cytology (FNAC), and in case, smears were stained with Hematoxylin and eosin (H and E), Giemsa, and ZN stain and categorized into three cytomorphological patterns. All the aspirates were inoculated on two sterile Lowenstein Jensen (LJ) medium. Result: Out of 400 cases of consecutive lymph nodes aspirated, 180 cases (45%) showed features of tuberculous lymphadenitis. Smears revealed epithelioid granulomas with caseous necrosis in maximum cases (40%). On statistical analysis, difference between group I and group II was found to be significant (P < 0.05); while comparison between groups II and III as well as between groups I and III was found to be statistically insignificant. Overall, acid fast bacilli positivity was seen in 51.6% of the cases. Conclusion: FNAC has been proved very safe, highly sensitive, and first line investigation in diagnosing tubercular lymphadenitis. The sensitivity can be further be increased by complementary cytomorphology with acid fast staining. Diagnostic accuracy can further be increased by culture.

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