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Spectrum of lymphadenopathy on fine needle aspiration cytology-A 3 year retrospective study in a tertiary care centre

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Author Details : Honey Bhasker Sharma, Megha Bansal*, Nikhilesh Kumar, Monika Gupta

Volume : 4, Issue : 1, Year : 2019

Article Page : 82-86

https://doi.org/10.18231/2456-9267.2019.0014

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Abstract

Abstract

Introduction: Lymphadenopathy is seen commonly in patients attending the medical outpatient departments. FNAC is an easy and rapid diagnostic test. FNAC gives early direction to treatment protocol to be followed.

Aim: To study the different cytological spectrum associated with various lymphadenopathy and different lesions with respect to age and sex.

Materials and Methods: In our study, all cases of peripheral lymphadenopathies who had come to the cytology department for FNAC over a period of 3 years from 1^st July 2015 to 1^st July 2018 were included. It was a retrospective study.

Results: During a course of threeyears a total of 100 cases were received and were studied. Of these 6 cases were inconclusive due to unsatisfactory and haemorragicsmears; 83 cases were benign and 11 cases were neoplastic. The ages of patients were from 6 months to 65 years. Males were 54 and females were 46 in number. Reactive (27 cases), granulomatous (30 cases), Tuberculosis (4 cases), suppurative (14 cases), necrotic (5 cases), lymph node with filariasis (2 cases), metastasis (8 cases), lymphomas (3 cases).

Conclusion: FNAC is an easy, quick and good test to offer rapid diagnosis for lymphadenopathies and guide towards appropriate and timely treatment without the need of biopsy.

Keywords: FNAC, Lymphadenopathy, Benign, Neoplastic, Reactive, Granulomatous, Metastasis.

Introduction

Lymphadenopathy is seen commonly in patients attending the medical outpatient deparments.^[1] The spectrum of diseases varies from an inflammatory process to a neoplastic lesion.^[2]

Table 1: Sex distribution of different lymph node lesions

Six cases were inconclusive. 83 cases were inflammatory and 11 cases were neoplastic

Table 4: Age distribution of lymph node lesions

Table 5: Different metastatic deposits in lymph nodes

Metastatic lesions	Males	Females	Total
Squamous cell ca	5	0	5
Adenocarcinoma	1	1	2
Undifferentiated	1	0	1

Table 6: Comparison of current study with other studies evaluating the causes for lymphadenopathy

Author	Total cases	Reactive	Granulomatous	Suppurative/ necrotic	Lymphoma	Tuberculosis	Metastasis	Inconclusive	Others (nonspecific)
Current study 2019	100	27	30	19	04	04	08	06	2(microfilaria)
Badge S A et al 2018	310	25	109	5	3	151	12	5	-
Sheela KM et al 2017	122	29	-	1	29	41	20	-	1
Gayatri MN et al 2015	1774	465	262	70	13	260	376	-	328
Attalla M et al 2014	235	108	110	-	10	-	05	-	02

 

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Fig. 1: Granulomatous Lymphadenitis

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Fig. 2: Acid Fast Bacilli Positive in ZN Stain of lymph node aspirate

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Fig 3: Microfilaria in lymph node aspirate

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Fig. 4: Non Hodgkins lymphoma on FNAC lymph node

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Fig. 5: Squamous cell carcinoma metastasis in lymph node

Discussion

Lymphadenopathy is a commonly seen clinical condition requiring quick and accurate diagnosis so that a proper treatment regimen can be started at the earliest. FNAC is a completely safe, quick and appropriate method for early diagnosis of lymphadenopathy reducing the need of excision biopsy.^[1]

In the present study 100 cases of palpable peripheral lympadenopathyfor a period of three years were studied retrospectively.

Aspirates were inconclusive in six cases due to unsatisfactory smears. The causes for unsatisfactory smears were scanty cellularityor hemorrhagic smears. Aspirates were benign in 83% and metastatic deposits were found in 8% and lymphoma in 3%. The pattern of lesion varied from nonneoplastic lesion like granulomatous, reactive

suppurative, necrotic, tubercular, microfilarial to neoplastic lesions like metastatic lymphadenopathy and lymphomas.

In our study cervical lymph nodes were involved mostly (84%) followed by axillary lymph nodes (7%). In a study done by Gayathri etal cervical group was the most commonly involved(74.6%) followed by axillary lymph nodes.?1;Comparison of current study with other studies evaluating the causes for lymphadenopathy is depicted in the table 6.

In a study done by PanditAA et al male to female ratio was equal our study was almost similar with slight male predominance. (M:F::1.1:1).?2;

In Granulomatous pathology was the most common cause of lymphadenopathy in our study similar to study done by Mir Attaullahetal.?3;

Study done by Badge et al showed 32% cases of granulomatous lymphadenitis. The granulomatous cases showed the presence of granulomas composed of epithelioid cells, histiocytes and lymphocytes but were negative for Acid fast bacilli on ZN stain. And those positive for AFB were diagnosed as tuberculosis.^[4]In our study maximum cases were reported as granulomatous. (30%) based on similar cytological features. while suppurative cases showed only sheets of neutropils and no granulomas.^[4]

^.In our study squamous cell carcinoma was the most common metastatic malignancy followed by adenocarcinoma similar to a study done by PramodPathyetal in which squamous cell carcinoma was the most common metastatic malignancy followed by adenocarcinoma and poorly differentiated carcinoma.^[5]

In a study done by Dr. Ripunjaya Mohanty et al cervical group was the most common to be involved by metastasis with squamous cell carcinoma being the most common histological type ^[6]

In our study majority of patients with metastatic squamous cell carcinoma in lymph nodes were above 50years. The finding of the study supported that metastatic squamous cell carcinoma is frequent after age of 40 years.^[7]

Lymphoproliferative disorders were diagnosed in only 4 cases and formed a very small percentage of the total pathologies reported which correlated with study done by Ramanan D et al in 2016 who also reported 4% cases.^[8]

In a study done by Akanksha Misra et al in 2017 Non-Hodkins lymphoma was diagnosed in 2.5 % cases.^[9] while in our study Non-Hodkins lymphoma was diagnosed in only 1% cases.

Tuberculosis is the commonest cause of lymphadenopathy in developing countries and should be considered in every case of granulomatous lympadenopathy unless proved otherwise.^[10]In their study, Khajuria et al found tuberculosis as the most common diagnosis.?1;° while in our study TB cases formed only 4% cases based on AFB stain positivity on Zeihl Neelsons staining.

The most commonly affected lymph nodes were cervical followed by supraclavicular, axillary, inguinal and post auricular in a study done by Sheela M et al in 2017.^[11]In our study also cervical was the commonest group involved.

In our study the highest number of cases were seen in 11-20years while in another study by Silas et al highest number of cases were in ages 10-14 years.^[12]and in another study by Mishra et al most common etiology of affected lymph nodes was tuberculous lympadenitis.^[13]

In a study done in 2014 by Bhavani et al, the most common causes of cervical lympadenopathy were tuberculosis, reactive hyperplasia and metastatic malignancies particularly squamous cell carcinoma.^[14] while in a study done by Devi Thaker et al in 2017 reactive hyperplasias were the most commonly found lesion in lymphadenopathies.^[15]In our study most common cause was granulomatous followed by reactive and suppurative and then metastasis and lymphomas.

Conclusion

FNAC is an easy and rapid diagnostic test for diagnosing inflammatory as well as neoplastic lesions. It is safe and appropriate tool for providing definite diagnosis in lymph nodes aspirates where biopsies can be avoided. The knowledge of cytological patterns of various lesions of lymph nodes in an area helps in better approach to the diagnosis. FNAC is suitable for developing countries with financial constraints where it can minimize the economic burden and avoid the need for excision biopsy.

Conflicts of Interest: None.

 

 

 

 

 

References

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How to cite : Sharma H B, Bansal M , Kumar N, Gupta M , Spectrum of lymphadenopathy on fine needle aspiration cytology-A 3 year retrospective study in a tertiary care centre. IP Arch Cytol Histopathol Res 2019;4(1):82-86

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